Background: Malignant bowel obstruction (MBO) is a common and distressing complication in advanced gastrointestinal cancers, significantly impacting patients’ quality of life. When conservative management fails, palliative decompression is essential to relieve symptoms such as nausea, vomiting, and abdominal distension. Venting gastrostomy is the most established method; however, anatomical challenges may necessitate alternative percutaneous approaches. Objective: This narrative review aims to provide a comprehensive overview of percutaneous gastrostomy techniques for palliative gastrointestinal decompression, including percutaneous endoscopic gastrostomy (PEG), interdisciplinary imaging-guided percutaneous or transhepatic gastrostomy, and percutaneous transesophageal gastrostomy (PTEG). Methods: A literature review was conducted to evaluate the indications, techniques, efficacy, and complications associated with these procedures. The role of a multidisciplinary approach, incorporating radiologic, endoscopic, and palliative care expertise, was also explored. Results: PEG remains the gold standard for venting gastrostomy, achieving symptom relief in up to 92% of cases, with a low complication rate. However, interdisciplinary imaging-guided percutaneous or transhepatic gastrostomy offers a viable alternative for patients with surgically altered anatomy or difficult percutaneous access. PTEG, a newer technique, has demonstrated high technical success and symptom improvement, particularly in patients with extensive peritoneal carcinomatosis or massive ascites, where transabdominal approaches are not feasible. Conclusions: Palliative percutaneous decompression provides effective symptom relief in advanced gastrointestinal cancer. The choice of technique should be individualized based on patient anatomy, clinical condition, and resource availability. A multidisciplinary approach remains crucial in tailoring decompression strategies to improve the quality of life in end-stage malignancies.
背景：恶性肠梗阻是晚期胃肠道癌症常见且令人痛苦的并发症，显著影响患者生活质量。当保守治疗无效时，姑息性减压对缓解恶心、呕吐及腹胀等症状至关重要。胃造口排气是最成熟的方法，但解剖结构异常可能需要替代性经皮穿刺技术。目的：本文旨在系统综述姑息性胃肠道减压的经皮胃造口技术，包括经皮内镜下胃造口术、多学科影像引导下经皮/经肝胃造口术以及经皮经食管胃造口术。方法：通过文献综述评估这些操作的适应证、技术要点、疗效及并发症，并探讨融合影像学、内镜与姑息治疗专业知识的跨学科协作模式的作用。结果：经皮内镜下胃造口术仍是排气式胃造口的金标准，症状缓解率高达92%且并发症发生率低。但对于解剖结构改变或经皮穿刺困难的患者，多学科影像引导下经皮/经肝胃造口术是有效替代方案。经皮经食管胃造口术作为新兴技术，在广泛腹膜癌转移或大量腹水等无法经腹操作的患者中展现出较高的技术成功率和症状改善效果。结论：姑息性经皮减压术能有效缓解晚期胃肠道癌症患者的症状。技术选择应基于患者解剖特征、临床状况及医疗资源进行个体化决策。采用多学科协作模式制定个体化减压策略，对提升终末期恶性肿瘤患者生活质量具有重要意义。
肿瘤(癌症)患者之家