EndoTODAY | EndoATLAS | Outpatient Clinic

Parasite | Esophagus | Stomach | Cancer | ESD

Home | Guide | Author | Search | Blog | Links


[Percutaneous endoscopic gastrostomy (PEG)]


1. ÀûÀÀÁõ ¹× ÁÖÀÇ»çÇ×

1. ÀϽÃÀû ȤÀº ¿µ±¸ÀûÀÎ ¿¬ÇÏ°ï¶õÀ¸·Î °æ±¸ ½ÄÀÌ°¡ ºÒ°¡´ÉÇÑ °æ¿ì·Î¼­ Åë»ó Àå±â°£ ºñÀ§°üÀ» ÅëÇÑ enteral feeding¿¡ ÀÇÁ¸Çϴ ȯÀÚ¿¡¼­ ½ÃÇàÇÑ´Ù.


°í·ÉȯÀÚÀÇ Ä¡·á¿¡¼­ PEG´Â Áß¿äÇÑ ¿ªÇÒÀ» Â÷ÁöÇÑ´Ù.

2. ´ëºÎºÐ CVA³ª Parkinsonism µî ½Å°æ°ú ȯÀÚ³ª À̺ñÀÎÈÄ°ú ¿µ¿ªÀÇ ¾Ç¼ºÁ¾¾çÀ» °¡Áø ȯÀÚ°¡ ´ë»óÀÌ µÈ´Ù. »ó±â ȯÀÚ¿¡¼­ ÀüÇô oral feedingÀÌ µÇÁö ¾Ê°Å³ª oral feedingÀÌ °¡´ÉÇÏ´õ¶óµµ ÈíÀμº Æó·ÅÀÌ ¹Ýº¹µÇ´Â °æ¿ì¿¡ PEG¸¦ ½ÃÇàÇÏ´Â °æ¿ì°¡ ¸¹´Ù.

3. Aspirin, clopidogrel µî Ç×Ç÷¼ÒÆÇÁ¦´Â º¸Åë 3-4ÀÏ ²÷°í ½ÃÇàÇÑ´Ù. ½Ã¼ú ´ÙÀ½ ³¯ ´Ù½Ã ½ÃÀÛÇÏ´Â °ÍÀÌ ÁÁ´Ù. ¿ÍÆĸ°µµ ²÷¾î¾ß ÇÏÁö¸¸ ¿ÍÆĸ°À» ²÷´Â ±â°£Àº ´ã´ç°ú°ú »óÀÇÇÏ¿© °áÁ¤ÇÑ´Ù.

4. PEG´Â ´ÜÁö À§·Î ¿µ¾çºÐÀ» Á÷Á¢ ³Ö¾îÁÖ´Â °Í¿¡ Áö³ªÁö ¾Ê±â ¶§¹®¿¡ ±âÁúÀû ȤÀº ±â´ÉÀû Æó¼â°¡ ÀÖ´Â °æ¿ì´Â ´ë»óÀÌ µÇÁö ¾Ê´Â´Ù. Åë»ó ºñÀ§°üÀ» ÅëÇÑ ¿µ¾ç°ø±Þ¿¡ ¹®Á¦°¡ ¾ø´Â ȯÀÚ¿¡¼­ Àå±â°£ÀÇ enteral feedingÀ» ÇÏ°íÀÚ ÇÒ ¶§ PEG¸¦ ½ÃÇàÇÏ´Â °ÍÀÌ´Ù.

5. PEG´Â Àå±â°£ÀÇ enteral feedingÀ» µµ¿ÍÁÖ´Â ¹æ¹ýÀ¸·Î ÀÀ±Þ½Ã¼úÀÌ ¾Æ´Ï´Ù. ȯÀÚÀÇ »óÅ°¡ unstableÇÑ °æ¿ì¿¡´Â Àý´ë·Î ½ÃÇàÇÏÁö ¾Ê´Â´Ù.

6. PEG »ðÀÔÀº ±¸°­À» ÅëÇÏ¿© Æ©ºê°¡ »ðÀԵDZ⠶§¹®¿¡ asepticÇÑ ½Ã¼úÀÌ ¾Æ´Ï´Ù. µû¶ó¼­ ±¹¼Ò °¨¿°ÁõÀÌ ÀÚÁÖ ¹ß»ýÇÒ ¼ö ¹Û¿¡ ¾ø´Ù. ±¹¼Ò °¨¿°ÁõÀº ´ëºÎºÐ 1ÀÏ 1-2ȸ Á¤µµÀÇ µå·¹½Ì°ú IV Ç×»ýÁ¦·Î È£ÀüµÇÁö¸¸, µå¹°°Ô Æ©ºê¸¦ Á¦°ÅÇØ¾ß ÇÏ´Â °æ¿ìµµ ÀÖ´Ù. ÀÌ¿ÜÀÇ ÇÕº´ÁõÀ¸·Î´Â leak, ÃâÇ÷, À§½Äµµ¿ª·ù, pneumoperitoneum µîÀÌ °¡´ÉÇÏ´Ù. ÇÕº´Áõ ¹ß»ý½Ã¿¡´Â ¿ì¼± ½Ã¼úÀÇ¿Í »óÀÇÇÏ¿© Æ©ºê ¹× external anchorÀÇ À§Ä¡¸¦ È®ÀÎÇÏ´Â °ÍÀÌ ÁÁ´Ù. Á¶±Ý Á¶¿©Áְųª Ç®¾îÁ־ ¹®Á¦°¡ ÇØ°áµÇ´Â °æ¿ì°¡ ¸¹±â ¶§¹®ÀÌ´Ù.

7. PEG »ðÀÔÀ» À§ÇÏ¿© ½Ã¼ú Àü ¿¹¹æÀû Ç×»ýÁ¦¸¦ Åõ¿©ÇÑ´Ù (°¡Àå ÃÖ±Ù systemic review)

8. Âü°í: European guidelineÀº ¾Æ·¡ ±×¸²À» clickÇϼ¼¿ä.

9. Âü°í: Cleveland ClinicÀÇ PEG ȯÀÚ ¼³¸í¼­

10. Âü°í: ASGEÀÇ PEG ȯÀÚ ¼³¸í¼­

12. Âü°í: YouTUBE ȯÀÚ ¼³¸í µ¿¿µ»ó


2. PEG »ðÀÔ È¯ÀÚ Ç¥ÁØ Ã³¹æ

ºÐ·ù ±âº»Ã³¹æ ¾àó¹æ °Ë»çó¹æ
Day 1 (ÀÔ¿ø) V/S q 8h
BR
TD --> MNNPO
Body weight check
Height check
Get permission (½Ã¼úµ¿ÀǼ­¿Í ¼ö¸é³»½Ã°æµ¿ÀǼ­)
XDNK2 IV 20gtt Chest X-ray, Ç¥ÁØ Ç÷¾×°Ë»ç
Day 2 (procedure day) V/S q 8h
BR
NPO
Send to endoscopy room
XDNK2 IV 20gtt
Cefazolin 1g IV (1ȸ on call)
.
Day 3 V/S q 8h
BR
NPO for 24hr after PEG --> ÀÌÈÄ feeding start (¾Æ·¡ ÂüÁ¶)
Daily dressing
XDNK2 IV 20gtt .


Pull techniqueÀ» ÀÌ¿ëÇÑ Ç¥ÁØ »ðÀÔ¹ý


Punture ÀÌÀü¿¡ transilluminationÀ» È®ÀÎÇØ¾ß ÇÑ´Ù.


³»½Ã°æÀ» »ðÀÔÇÒ ¼ö ¾ø´Â ȯÀÚ¿¡¼­´Â PEG¸¦ ÇÒ ¼ö ¾øÀ¸¹Ç·Î , ¿µ»óÀÇÇаú¿¡ ÀÇ·ÚÇÏ¿© PRG¸¦ ÇØ¾ß ÇÑ´Ù.


3. »ç·Ê: ½Äµµ stent ȯÀÚÀÇ PEG

ÁøÇ༺ ½Äµµ¾ÏÀ¸·Î esophageal obstruction°ú tracheo-esophageal fistula°¡ À־ covered stent¸¦ ³ÖÀº ȯÀÚÀÔ´Ï´Ù. Stent ½Ã¼ú ÈÄ¿¡µµ Áö¼ÓÀûÀÎ aspirationÀÌ À־ °æ±¸ ½ÄÀ̼·Ãë°¡ ¾î·Æ´Ù°í ÆǴܵǾî PEG »ðÀÔÀÌ ÀǷڵǾú½À´Ï´Ù. Stent·Î ÀÎÇÏ¿© ½Äµµ°¡ ÃæºÐÈ÷ ³Ð¾îÁöÁö ¾Ê¾Ò´Ù¸é PEG tube°¡ ½Äµµ¸¦ Åë°úÇÏÁö ¸øÇÒ °¡´É¼ºÀÌ ÀÖ´Â »óȲÀ̾ú½À´Ï´Ù. ±×·¯³ª ´ÙÇེ·´°Ôµµ 9.2 mm ¿Ü°æÀÇ ³»½Ã°æÀÌ ÀúÇ×¾øÀÌ ½Äµµ¸¦ Åë°úÇÒ ¼ö À־ Åë»óÀûÀÎ ¹æ¹ýÀ¸·Î PEG ½Ã¼úÀÌ °¡´ÉÇÏ¿´½À´Ï´Ù.

½Äµµ stent¿¡ dirty whiteÇÑ exudate°¡ ÀÖ¾ú°í ÀÌ ºÎÀ§¸¦ tube°¡ Åë°úµÇ¾ú±â ¶§¹®¿¡ PEG tubeÀÇ contamination Á¤µµ´Â Åë»óº¸´Ù ³ôÀ» ¼ö ¹Û¿¡ ¾ø´Ù°í ÆǴܵǾî ÃÖ´ëÇÑ ¼Òµ¶À» ÇÏ¿´°í 1-2ÀÏ Á¤µµÀÇ IV Ç×»ýÁ¦ »ç¿ëÀ» ±ÇÇÏ¿´½À´Ï´Ù.


4. PEGÈÄ ½ÄÀÌ ÁøÇà

º¹ºÎÆظ¸ÀÌ ¾ø°í, ÀåÀ½ÀÌ µé¸®¸é feedingÀ» ¾Æ·¡¿Í °°Àº ¼ø¼­·Î ½ÃÀÛÇÑ´Ù.

1. N/S 50 ml per 1hr (3 times)

2. SFD feeding if aspiration (-) after 4hr

3. SFD 50 ml - water 50 ml to prevent tube obstruction

4. Increase SFD 50 ml every 4hr up to 250 ml

5. SFD every 3hr after 250 ml

6. SFD every 2hr


5. Peristomal wound infection

PEGÀÇ °¡Àå ÈçÇÏ°í Áß¿äÇÑ ÇÕº´ÁõÀº wound infectionÀÔ´Ï´Ù. Á¦°¡ fellowÀÌ´ø ½ÃÀý ÀÌ¿¡ °üÇÑ ÂªÀº ³í¹®À» ¾´ ÀûÀÌ ÀÖ¾î ¼Ò°³ÇÕ´Ï´Ù. ´ç´¢È¯ÀÚ¿¡¼­´Â wound infectionÀÌ ´õ¿í ¸¹´Ù´Â ³»¿ëÀ̾ú½À´Ï´Ù.

Increased risk of peristomal wound infection after percutaneous endoscopic gastrostomy in patients with diabetes mellitus Dig Liver Dis 2002;34:857-61


Wound infection


Severe wound infection - necrotizing fasciitis


6. ±âŸ ´Ù¾çÇÑ ÇÕº´Áõ


Pneumoperitoneum


PEG ÈÄ hematemesis 200 ml


Buried bumper syndrome (partial)


Pressure necrosis


Á¤½Ä PEG tube°¡ ¾Æ´Ñ Foley catheter¸¦ »ðÀÔÇÑ ÈÄ ³»¿øÇÑ È¯ÀÚ¿¡¼­ ¹ß°ßµÈ pressure necrosis


PEG ÈÄ ¹ß»ýÇÑ °áÀå-ÇǺΠfistula


PEG 3ÀÏ ÈÄ ¹ß»ýÇÑ Mallory Weiss tear


7. PEG tubeÀÇ Á¦°Å ¹× ±³Ã¼

1) PEG Æ©ºê¸¦ »ðÀÔÇÏ°Ô µÈ ÀÌÀ¯°¡ ¼Ò¸êµÈ °æ¿ì PEG tube¸¦ Á¦°ÅÇÑ´Ù.

2) PEG Æ©ºê¸¦ Á¦°ÅÇÏ´Â ¹æ¹ýÀº µÎ °¡Áö°¡ ÀÖ´Ù. (1) BlindÇÑ ¹æ¹ýÀ¸·Î PEG Æ©ºê¸¦ ¸ö ¹Û¿¡¼­ ´ç°Ü¼­ Á¦°ÅÇÏ´Â ¹æ¹ý, (2) ³»½Ã°æÀ» À§³»¿¡ »ðÀÔÇÑ »óÅ¿¡¼­ ¸ö ¹Û¿¡¼­ Æ©ºê¸¦ ÀÚ¸£°í internal bumper´Â ³»½Ã°æÀ» ÅëÇÏ¿© ¼ö°ÅÇÏ´Â ¹æ¹ý. PEG Æ©ºê¸¦ Á¦°Å ÈÄ ³²¾ÆÀÖ´Â fistula openingÀº 2ÀÏ Á¤µµ ±Ý½ÄÇÏ¸é ´ëºÎºÐ ÀúÀý·Î ¸·Èù´Ù. ¸·È÷Áö ¾Ê´Â °æ¿ì histoacrylÀ» »ç¿ëÇÒ ¼ö ÀÖ´Ù.

 ¸ö ¹Û¿¡¼­ PEG Æ©ºê¸¦ ´ç°Ü¼­ Á¦°ÅÇÏ´Â ¹æ¹ý

 Æ©ºê Á¦°Å Á÷ÈÄÀÇ fistula. ´ëºÎºÐ ÇÏ·ç ³»¿¡ ¿ÏÀüÈ÷ ¸·Èù´Ù.

3) PEGÀÇ ±³Ã¼´Â À§ÀÇ ¹æ¹ý¿¡ µû¶ó Æ©ºê¸¦ Á¦°ÅÇÑ ÈÄ ±× ÀÚ¸®¿¡¼­ Áï½Ã fistula tractÀ» ÅëÇÏ¿© ±³Ã¼¿ë Æ©ºê¸¦ »ðÀÔÇÑ´Ù. ±×·¯³ª ¿ëÀÌÇÏÁö ¾ÊÀº °æ¿ì¿¡´Â Æ©ºê Á¦°Å ¼öÀÏ ÈÄ¿¡ ¾à°£ ¿· ºÎºÐ¿¡ PEG Æ©ºê¸¦ »õ·Î »ðÀÔÇÑ´Ù.


8. Àý´ÜÇÑ PEG tube bumper°¡ »óºÎ½Äµµ¿¡ °É¸° °æ¿ì 2¿¹

PEG tube°¡ ÇÊ¿ä¾ø°Ô µÇ¸é ±×³É ÈûÀ¸·Î Àâ¾Æ´ç±â¸é ºüÁý´Ï´Ù. °£È¤ PEG tractÀÇ ¼Õ»óÀ» ¿ì·ÁÇÏ¿© internal bumper 2-3cm »ó´ÜÀÇ tube¸¦ °¡À§·Î Àý´ÜÇÏ¿© ³»½Ã°æÀ¸·Î Á¦°ÅÇϱ⵵ ÇÕ´Ï´Ù. ±× °úÁ¤¿¡¼­ »óºÎ½Äµµ¿¡ °É¸± ¼ö ÀÖ½À´Ï´Ù. ÇÑ ºÐÀº midazolam Åõ¿© ÈÄ Á¦°ÅÇÒ ¼ö ÀÖ¾ú°í ÇÑ ºÐÀº À̺ñÀÎÈÄ°ú¿¡ ÀÇ·ÚÇÏ¿© rigid esophagoscope·Î Á¦°ÅÇÏ¿´½À´Ï´Ù.


³»½Ã°æ »ðÀÔÇÏ¿¡ PEG Æ©ºê¸¦ Á¦°ÅÇÏ´Ù internal bumper°¡ ½Äµµ¿¡ °É·Á midazolam Åõ¿© ÈÄ Á¦°Å°¡ °¡´ÉÇÏ¿´´ø °æ¿ì


À̺ñÀÎÈÄ°ú¿¡ ÀÇ·ÚÇÏ¿© rigid esophagoscope·Î Á¦°ÅÇÑ °æ¿ì


9. PEG tractÀÌ ¸·È÷Áö ¾ÊÀ½

PEG tube¸¦ »ÌÀ¸¸é tract´Â ÀúÀý·Î ¸·Èü´Ï´Ù. ±×·±µ¥ ƯÀÌÇÏ°Ôµµ ÀúÀý·Î ¹ÍÈ÷Áö ¾ÊÀº ȯÀÚ°¡ À־ Á¶Á÷Á¢ÇÕÁ¦·Î Ä¡·áÇÑ ¿¹°¡ ÀÖ¾ú½À´Ï´Ù.



À§Ã¼ÇϺÎÀüº®¿¡ PEG°¡ °üÂûµÇ¸ç ¹Ù·Î ¿·¿¡ ¾à 1mm Å©±âÀÇ holeÀÌ °üÂûµÊ. Injection catheter¸¦ ÀÌ¿ëÇÏ¿© histoacryl 0.5ml¿Í lipiodol 0.5mL¸¦ ¼¯¿©¼­ ´©°ø °ü¿¡ ÁÖÀÔÇÔ. ½Ã¼úµµÁß Æ¯º°ÇÏ ÇÕº´ÁõÀÌ ¾ø´Â °ÍÀ» È®ÀÎÇÏ°í °Ë»ç Á¾·á


10. Balloon-type replacement tube »ç¿ë¼³¸í¼­¿Í Çö½ÇÀûÀÎ Àû¿ë

 Ç³¼±Çü ±³Ã¼ Æ©ºê

¹îÁÙ(PEG Æ©ºê)À» óÀ½ »ðÀÔÇÒ ¶§¿¡´Â ¹ö¼¸Çü Æ©ºê¸¦ ¾²Áö¸¸ º¯°æÇÒ ¶§¿¡´Â dz¼±ÇüÀ» »ç¿ëÇÏ°í ÀÖ´Ù. ȸ»çÃø »ç¿ë¼³¸í¼­¿¡´Â ¾Æ·¡¿Í °°ÀÌ ¾º¿©Á® ÀÖ´Ù.

Check balloon volume every 7 to 10 days for correct inflation volume using the following steps;
- Discontinue feeding
- Use a luer-tip syringe to completerly evacuate water from balloon
- Discard evacuated water
- Reinflate balloon with appropriate amount of water (20 ml).

For optimal performance, the tube should be replaced every 30 days or as required to ensure balloon patency and unoccluded tube lumen.


[Balloon-type replacement tube ȯÀÚ ¹× º¸È£ÀÚ¿¡ ´ëÇÑ ¼³¸í]

dz¼±Çü ±³È¯Æ©ºê´Â óÀ½ »ðÀÔÇÑ ¹ö¼¸Çü Æ©ºê¿¡ ºñÇÏ¿© ºüÁú À§ÇèÀÌ ³ô½À´Ï´Ù. ȸ»çÃø »ç¿ë ¼³¸í¼­¿¡´Â 7-10Àϸ¶´Ù ÁÖ»ç±â¸¦ ÀÌ¿ëÇÏ¿© ÀÌ¿ëÇÏ¿© dz¼±ÀÇ ¹°À» »©°í »õ ¹°À» 20 ml ³Ö¾îÁÖµµ·Ï µÇ¾î ÀÖ½À´Ï´Ù (Áõ·ù¼ö¿Í ÁÖ»ç±â´Â ÀÇ·á±â»ó¿¡¼­ °³º° ±¸ÀÔ). ȸ»çÃø »ç¿ë¼³¸í¼­¿¡¼­´Â Æ©ºê¸¦ 30ÀÏ °£°ÝÀ¸·Î ±³È¯Çϵµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù.

»ç½Ç ÇÑ´Þ¸¶´Ù Æ©ºê¸¦ ¹Ù²Ù´Â °ÍÀº ½¬¿î ÀÏÀÌ ¾Æ´Õ´Ï´Ù. µû¶ó¼­ ±³Ã¼ÇÏÁö ¾Ê°í ±×³É »ç¿ëÇÏ´Ù°¡ ¸·È÷°Å³ª º¯»öµÇ¾úÀ» ¶§ ¹Ù²Ù´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ´Ü Á¤ÇØÁø ±³È¯Áֱ⺸´Ù ¿À·¡ »ç¿ëÇÏ´Â °æ¿ì dz¼±ÀÇ ´©¼ö·Î ÀÎÇÏ¿© Æ©ºê°¡ ºüÁú À§ÇèÀÌ ³ô´Ù´Â Á¡Àº ¾Ë°í °è¼Å¾ß ÇÕ´Ï´Ù. ¸¸¾à Æ©ºê°¡ ºüÁö¸é ±× Áï½Ã Æ©ºê¸¦ ´Ù½Ã ¹Ð¾î ³Ö°í ÀÀ±Þ½Ç·Î ¿À½Ã±â ¹Ù¶ø´Ï´Ù. ¼öºÐ ÀÌ»ó ÁöüµÇ¸é °ú°Å¿¡ ¸¸µé¾ú´ø ±¸¸ÛÀ» »ç¿ëÇÒ ¼ö ¾ø½À´Ï´Ù.

ȸ»çÀÇ Ãßõ°ú Çö½ÇÀûÀÎ Ãø¸éÀ» °í·ÁÇÏ¿© 2ÁÖ¿¡ Çѹø ¹°À» ¹Ù²Ù°í 3´Þ¿¡ Çѹø Æ©ºê ±³Ã¼¸¦ ÃßõÇÕ´Ï´Ù. °£È¤ ¹°À» ¹Ù²ÙÁö ¾Ê°í ±×³É ¾²½Ã´Â ºÐÀÌ °è½Ã´Âµ¥ ¿ÇÀº ¹æ¹ýÀº ¾Æ´Õ´Ï´Ù.


11. Non-balloon type replacement tube

¼ö³â Àü °©ÀÚ±â non-balloon type replacement tube°¡ ¼öÀÔÁߴܵǾî balloonÇüÀ» »ç¿ëÇÏ°í ÀÖ¾ú½À´Ï´Ù. 2012³â ¸» ¿ì¸®³ª¶óÀÇ ÇÑ È¸»ç¿¡¼­ non-balloon type replacement tube¸¦ »ý»êÇϱ⠽ÃÀÛÇÏ¿´´Ù°í ÇÕ´Ï´Ù. Àú´Â ¾ÆÁ÷ ½á º» ÀûÀº ¾ø½À´Ï´Ù.

±ä tube°¡ ¾ø´Â button typeÀ̶ó´Â °Íµµ Àִµ¥ Àú´Â Çѹøµµ ½á º» ÀûÀÌ ¾ø½À´Ï´Ù.


12. PEG leak¿¡ ´ëÇÑ Åä·Ð

[2014-6-28. ¾Öµ¶ÀÚ Áú¹®] Àú´Â ºÎ»êÀÇ Á¾ÇÕº´¿ø¿¡¼­ ÀÏÇÏ°í ÀÖ´Â ¼ÒÈ­±â³»°ú ÀÇ»çÀÔ´Ï´Ù. º´¿ø¿¡¼­ PEG ½Ã¼úÀ» ÇÏ°í PEG tube¸¦ ±³Ã¼ÇØ ÁÖ°í ÀÖ½À´Ï´Ù. Àß »ç¿ëÇÏ´Ù°¡ tube ¿·À¸·Î ½ÄÀÌ°¡ »õ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ½ÉÇÑ ºÐµéÀº °è¼Ó »õ¾î ³ª¿Í¼­ °æ¿ì¿¡ µû¶ó ´õ Å« Á÷°æÀÇ tube·Î ±³Ã¼ÇØ ÁÖ°í ÀÖ½À´Ï´Ù. Á¦°¡ ¾Ë¾Æ º» ºÁ¿¡ ÀÇÇÏ¸é °¡Àå Å« Á÷°æÀÇ tube°¡ 24Fr Àε¥ ÀÌ°ÍÀ» ÇÏ°í ÀÖ´Â ºÐÀÌ »õ¸é ¾î¶»°Ô ÇØ ÁÖ¾î¾ß ÇÒÁö ¸ð¸£°Ú½À´Ï´Ù. ÁÁÀº ¹æ¹ýÀÌ ¾øÀ»±î ÇÏ¿© ¹®ÀÇ µå¸³´Ï´Ù.


[2014-6-29. ÀÌÁØÇà ´äº¯] Àú´Â ÀÌ ºÎºÐ¿¡ °æÇèÀÌ º°·Î ¾ø¾î ¿©·¯ ±³¼ö´Ôµé²² ÀÇ°ßÀ» ¿©ÂÞ¾ú½À´Ï´Ù. ¾Æ·¡ ´äº¯µéÀ» Âü°íÇϽñ⠹ٶø´Ï´Ù.

[´äº¯ 1] PEG site leak°¡ ÀÖ´Â °æ¿ì´Â PEGÀÇ ¿Ü°æÀÌ µÎ²¨¿î °ÍÀ¸·Î ±³Ã¼ÇÏ´Â °Íº¸´Ù´Â ±âÁ¸ PEG¸¦ Á¦°ÅÇÏ°í closure¸¦ ½ÃŲµÚ »õ·Î PEG stomy¸¦ ¸¸µé¾î¾ß ÇÑ´Ù°í ¹è¿ü´ø °Í °°½À´Ï´Ù. ±³Ã¼¿Í »õ·Î ¸¸µå´Â °ÍÀ» ºñ±³ÇÑ RCT¸¦ º» ÀûÀº ¾ø½À´Ï´Ù. PEG leak°¡ Çѹø »ý±â¸é ¾î¶»°Ô Çصµ È£ÀüÀÌ ¾ø¾î¼­ °á±¹ ±âÁ¸ PEG¸¦ Á¦°ÅÇÏ°í »õ·Î¿î ÀÚ¸®¿¡ PEG¸¦ ¸¸µç ÀûÀÌ ¼­³Ê¹ø ÀÖ½À´Ï´Ù.

[´äº¯ 2] PEG leakageÀÇ °æ¿ì ȸ»ç¿¡ ¾Ë¾Æº¸¸é, 24Fr º¸´Ù Å« °ÍÀÌ ÀÖ½À´Ï´Ù. Àúµµ ÀÌÀü¿¡ 24 Fr¿¡¼­ 28, 30 Fr±îÁö ±³È¯ÇØ º» ÀûÀÌ ÀÖ½À´Ï´Ù. Å« °ÍÀ¸·Î ¹Ù²Ù´Â °ÍÀ» ±â´Ù¸®´Â µ¿¾È ¸çÄ¥ NPO ÇÏ´Ù º¸¸é, PEG site°¡ Á¼¾ÆÁ®¼­ ¿ÀÈ÷·Á ´õ ÀÛÀº °ÍÀ¸·Î »ðÀÔÇÒ ¼öµµ ÀÖ½À´Ï´Ù. 2-3ÀÏ ³»¿¡ ¹Ù·Î ¸·È÷Áö´Â ¾Ê°í, ¸¹ÀÌ Á¼¾ÆÁý´Ï´Ù. ±Ý½ÄÇÏ°í ¸ÅÀÏ dressingÇϸ鼭 PEG site¸¦ °üÂûÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. 3ÀÏ Á¤µµ Áö³ª¸é ¸·Èú ¼öµµ ÀÖ½À´Ï´Ù.

[´äº¯ 3] PEG leakage°¡ ÀÖ´Â °æ¿ì ¿ø·¡º¸´Ù ÀÛÀº °üÀ» ³Ö¾î¾ß Á÷°æÀÌ ÁÙ¾îµé¸é¼­ leak°¡ ÁÁ¾ÆÁý´Ï´Ù. Å« Æ©ºê¸¦ ³ÖÀ¸¸é Á¡Á¡ Ä¿Áý´Ï´Ù. ÀÛÀº tube·Î ³ÖÀ¸¸é ÁÖº¯ÀÌ »õ±â¶§¹®¿¡ ±Ý½ÄÀ» ½ÃÅ°°í Ç×»ýÁ¦¸¦ »ç¿ëÇϸ鼭 »óó°¡ ÁÁ¾ÆÁö±â ±â´Ù¸³´Ï´Ù. ´ëºÎºÐ °¨¿°ÀÌ µÇ¸é¼­ »óó°¡ ³ªºüÁö±â ¶§¹®ÀÔ´Ï´Ù. ¸Â´Â °ÍÀÌ ¾ø¾î Àú´Â Foley tube¸¦ »ç¿ëÇϸ鼭 Çß¾î°í ÁöÁöÇÒ ¼ö ¾ø¾î¼­ Æ©ºê ³¡¿¡ saline bagÀ» ´Þ¾Æ ¾à°£ ´ç°ÜÁö°Ô ÇÏ¿´¾ú½À´Ï´Ù. °ü°ÇÀº ÀÛÀº Æ©ºê¸¦ ³Ö°í ±Ý½ÄÇÏ¿© »óóÁÖº¯¿¡ ÁöÀúºÐÇÑ ºÐºñ¹°À̳ª À½½Ä¹° À§¾×ÀÌ ´ú ³ª¿Àµµ·Ï Çϸ鼭 »óó°¡ ³ª¾Æ¾ß ±¸¸ÛÀÌ ÀÛ¾ÆÁý´Ï´Ù.

[´äº¯ 4] Leakage°¡ ÀÖ´Ù°í ±¸°æÀÌ Å« °ÍÀ¸·Î ±³Ã¼ÇÏ¸é ´õ ³Ð¾îÁ® ¿ÀÈ÷·Á ¾ÇÈ­µÉ ¼ö ÀÖ¾î ÃßõÇÏÁö ¾Ê½À´Ï´Ù. ÀÚÁÖ dressingÇÏ°í gauze¸¦ °¥¾ÆÁÖ¾î ¸»¸®´Â °ÍÀÌ ÃÖ¼±ÀÇ ¹æ¹ýÀ̶ó°í »ý°¢ÇÕ´Ï´Ù. ±×·¡µµ ¾ÈµÇ¸é Á¦°ÅÇÏ°í ´Ù¸¥ °÷¿¡ »õ·Î Çغ¼ ¼ö ÀÖÀ¸³ª ¹Ýº¹µÉ °¡´É¼ºÀÌ ³ô½À´Ï´Ù.

[´äº¯ 5] ÀÌ·ÐÀûÀ¸·Î º¹¾ÐÀ» ³·Ãß´Â °ÍÀÌ µµ¿òÀÌ µË´Ï´Ù. Ç㸮¸¦ ´À½¼ÇÏ°Ô ÇÏ´Â ¿ÊÀ» ÀÔ°Ô ÇÏ°í °¡½ºÂ÷´Â À½½ÄÀ» Á» ÁÙÀÌ°í ½Ä»ç¾çÀ» Á¶ÀýÇÏ¿© ³Ê¹« ºü¸£°Ô Åõ¿©µÇÁö ¾Ê°Ô ÇÏ´Â °ÍµéÀÌ ÇÊ¿äÇÒ °Í °°½À´Ï´Ù.

[´äº¯ 6] Ưº°È÷ ¿°ÁõÀÌ ÀְųªÇÑ ¹®Á¦°¡ ¾ø´Ù¸é Àú °°Àº °æ¿ì »õ·Î Æ©ºê¸¦ ±³Ã¼Çغ¸°íµµ À½½ÄÀÌ »õ¾î³ª¿À¸é 4½Ã°£ Á¤µµ Á¦°Å¸¦ Çß´Ù°¡ Àç»ðÀÔÀ» ÇÕ´Ï´Ù. µÎ ¹ø ¹Û¿¡ Çغ¸Áö ¾Ê¾ÒÁö¸¸ ¸ðµÎ ÀÌÈÄ leakage°¡ ¾ø¾ú½À´Ï´Ù. Á¦°Å ½Ã°£Àº Æ©ºê¿Í ´©°øÀÇ ÀÌ°Ý¿¡ µû¶ó Á¶±Ý Á¶ÀýÇغ¸¸é µÇÁö ¾ÊÀ»±î »ý°¢ÇÕ´Ï´Ù. µÎ ¹ø ´Ù balloon type À¸·Î ³Ö¾ú½À´Ï´Ù (ÀÌÀü¿¡µµ balloon type À¸·Î °¡Áö°í ÀÖ¾ú´ø ºÐµéÀ̾ú½À´Ï´Ù). ´À½¼ÇØÁ³´ø °ÍÀÌ Á¶±Ý ÃÎÃÎÇØÁø Á¤µµÀÇ ´À³¦À̾ú°í ´ÙÇàÈ÷ Å« ¹«¸®¾øÀÌ µé¾î°¬½À´Ï´Ù. ¸¸¾à ³Ê¹« Á¼¾ÆÁ®¼­ ¾Èµé¾î°¡¸é dome-type tube·Î ³Ö¾î¾ß ÇÏ°Ú°í.. ±×·¡¼­ ½Ã°£ÀÌ Áß¿äÇÒ °Í °°½À´Ï´Ù. Àúµµ 4½Ã°£ ±â´Ù¸®¸é¼­ ¾à°£ °ÆÁ¤Àº µÇ¾ú¾úÁö¸¸ ´ëºÎºÐ ±¦ÂúÁö ¾ÊÀ»±î »ý°¢µË´Ï´Ù. "4½Ã°£Àº ¿ÏÀüÈ÷ ÀúÀÇ ´Ü¼ø °áÁ¤À̾ú½À´Ï´Ù." ±×¸®°í È¿°ú°¡ ¸ðÀÚ¶ó´Ù ½ÍÀ¸¸é ballloon type ÀÌ´Ï ºÎ´ã¾øÀÌ 6½Ã°£ »©º¸°í ´Ù½Ã ³Ö´Â µîÀ¸·Î ÇÏ¸é µÇÁö ¾ÊÀ»±î »ý°¢µË´Ï´Ù.

[´äº¯ 7] PEG ½Ã¼ú ÈÄ °Þ°Ô µÇ´Â °¡Àå °ï¶õÇÑ °æ¿ìÁßÀÇ Çϳª°¡ peristomal leakageÀÎ °Í °°½À´Ï´Ù. ÀÌ·ÐÀûÀ¸·Î´Â percutaneous gastrostomy°¡ Çü¼ºµÈ »óÅÂÀ̹ǷΠleakage°¡ ÀÖ´Ù°í ¹®Á¦°¡ µÉ °ÍÀº ¾øÁö¸¸ ¿©°£ ºÒÆíÇÑ °ÍÀÌ ¾Æ´Ï¸ç, ÀϺΠȯÀÚµéÀº ½Ã¼úÀÌ À߸øµÈ °ÍÀ¸·Î ¿ÀÇØÇϱ⵵ ÇÏ´Â °Í °°½À´Ï´Ù. Ưº°ÇÑ ¿¹¹æ ¹æ¹ýÀÌ ¾øÀÌ ½Ã¼ú ´ç½Ã¿¡ ½Å°æÀ» ½á¼­ Àý°³°¡ Æ©ºê Á÷°æ¿¡ ºñÇØ ³Ê¹« Å©°Ô µÇÁö ¾Êµµ·Ï ¾à°£ ²¿¿Á ³¢ÀÌ´Â ´À³¦À¸·Î ½Ã¼úÇÏ°í ÀÖ½À´Ï´Ù. óÀ½¿¡ ¾à°£ ³¢ÀÌ´Â ´À³¦ÀÌ À־ ½Ã°£ÀÌ Áö³ª¸é ¾ß°£ ´À½¼ÇØÁö´Â °æÇèÀ» ¸¹ÀÌ Ç߱⠶§¹®ÀÔ´Ï´Ù. ƯÈ÷, óÀ½ Àý°³°¡ Å©Áö ¾Ê´õ¶óµµ ½Ã¼ú Ãʱ⿡ tract maturationÀÌ µÇ±â Àü¿¡ tube°¡ ¸¹ÀÌ ¿òÁ÷À̰ųª (ȯÀÚ°¡ ±âħÀ» ÇÏ´Â °æ¿ì µî) ÇǺÎÀÇ Åº·Â°ú ÇÇÇÏÁö¹æÀÌ Àû¾î¼­ ÀûÀýÇÏ°Ô ¿ÏÃæ½ÃÄÑÁÖÁö ¸øÇϴ ȯÀڵ鿡¼­ ¸¹ÀÌ ¹ß»ýÇÏ´Â °Í °°½À´Ï´Ù. ÀÏ´Ü ¹ß»ýÇϸé Á»´õ Å« Á÷°æÀÇ tube·Î ±³Ã¼ÇØ º»´Ù°Å³ª, tract ÁÖÀ§ ¿°Áõ°ú ÇǺΠÁø¹°ÀÌ ¾Æ¹°¶§±îÁö dry up ½ÃŲ ÈÄ ´Ù½Ã tube¸¦ ÀçÅõ¿©ÇØ º¸°í, ±×·¡µµ leakage°¡ È£ÀüµÇÁö ¾Ê´Â´Ù¸é ´Ù¸¥ À§Ä¡¿¡ ´Ù½Ã tractÀ» ¸¸µé°í »õ·Î¿î tube¸¦ »ðÀÔÇÏ´Â ¹æ¹ýÀ» »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. Á¤´äÀÌ ¾ø´Â ¹®Á¦ÀÎ °Í °°¾Æ °³ÀÎÀûÀÎ °æÇèÀ» ¸î ÀÚ Àû¾îºÃ½À´Ï´Ù.

[´äº¯ 8] ´ë°³ PEG ´Â 2Â÷ º´¿ø¿¡¼­ ¸¹ÀÌ ÇÏ°Ô µÇÁö¿ä. Á¦ °æÇèÀ¸·Î´Â
1. ±âÁ¸ÀÇ PEG tube Á¦°ÅÇÏ°í, dressing ¸¸ Çϸ鼭 previous site °¡ °ÅÀÇ ¾Æ¹°¶§±îÁö ±â´Ù¸³´Ï´Ù. À̶§ foley catheter µî ´Ù¸¥ À̹°Áú·Î ±âÁ¸ÀÇ site¸¦ À¯ÁöÇÏ·Á°í ³ë·ÂÇÏ½Ç ÇÊ¿ä°¡ ¾ø½À´Ï´Ù. À̹°ÁúÀÌ ÀÖ´Â ÇÑ ÇǺΠº´º¯Àº healing µÇ±â ¾î·Á¿î °Í °°½À´Ï´Ù.
2. À̶§ tube site cultre ¸¦ ÇÏ°í, Ç×»ýÁ¦¸¦ »ç¿ëÇϱ⵵ ÇÕ´Ï´Ù. persistent leaking ÀÌ µÇ´Â °æ¿ì ÀÏÂ÷ÀûÀ¸·Î ȤÀº ÀÌÂ÷ÀûÀ¸·Îµµ °¨¿°ÀÌ ¹®Á¦°¡ µÇ±â ¶§¹®ÀÔ´Ï´Ù.
3. ±âÁ¸ÀÇ tube site °¡ pin-point ȤÀº °ÅÀÇ ¸Â¹°¸®¸é, ±×¶§ »õ·Î¿î gastrostomy ¸¦ óÀ½°ú °°Àº ¹æ¹ýÀ¸·Î ³Ö¾îÁÖ¸é µË´Ï´Ù. À̶§ Á¼ÇôµÐ ±âÁ¸ÀÇ tube site ´Â knife·Î ³ÐÈ÷Áö ¾Ê°íµµ ½±°Ô È®ÀåµË´Ï´Ù.
ÃÖ´ë 2ÁÖ Á¤µµ±îÁö ȯºÎ°¡ ¾Æ¹°±â¸¦ ±â´Ù¸° Àûµµ Àִµ¥, À̶§´Â infection ÀÌ °°ÀÌ ÀÖ¾ú½À´Ï´Ù. ´ë°³´Â 1ÁÖ Á¤µµ ±â´Ù¸®¸é ȯºÎ°¡ Á¼¾ÆÁö°í, ÀÌ ±â°£µ¿¾ÈÀº ÀÔ¿øÇÏ¿© ±Ý½Ä & ¼ö¾×Ä¡·á ÇÏ°í ÀÖ½À´Ï´Ù. ³Ê¹« ´À½¼ÇÏ¿© leaking ÀÌ ½ÉÇÑ °æ¿ì´Â ¿Ü°ú¿Í »óÀÇÇÏ¿© ÇǺο¬ºÎÁ¶Á÷±îÁö ±¹¼ÒÀûÀ¸·Î stitchÇÑ °æ¿ìµµ ÀÖ½À´Ï´Ù. ±³°ú¼­ÀûÀÎ ³»¿ëÀÌ ¾ø´Â °³ÀÎÀû °æÇèÀÌÁö¸¸ µµ¿òÀÌ µÇ¼Ì±â¸¦ ¹Ù¶ø´Ï´Ù.

[Home|IM1 Áø·á±æÀâÀÌ|EndoTODAY]