远端胃大部切除术后胃瘫22例临床分析  

Clinical analysis of 22 cases with postsurgical gastroparesis syndrome after distal subtotal gastrectomy

作　　者：冯伟东[1] 王亮[1] 余红兰[1] 

机构地区：[1]中山大学附属第一医院东山院区外科,广州510080

出　　处：《消化肿瘤杂志（电子版）》2011年第2期113-116,共4页Journal of Digestive Oncology(Electronic Version)

摘　　要：目的探究远端胃大部切除术后残胃胃瘫综合征的影响因素、预防及治疗。方法回顾性分析我院外科492例远端胃大部切除术患者以及其中22例胃瘫综合征患者的临床资料,分析胃瘫发生的相关危险因素,比较其治疗方法。结果本组胃瘫综合征发生率为4.5%。单因素分析结果显示,围手术期高血糖、术前营养不良、焦虑、术前幽门梗阻、BillrothⅡ式吻合、吻合口瘘、术中保留迷走神经干切断与胃瘫发生有关。多因素分析结果显示,术前幽门梗阻、BillrothⅡ式胃肠吻合、存在精神因素、吻合口瘘是胃瘫发生的主要危险因素。保守治疗有效,所有患者痊愈,平均恢复时间为(13.05±7.79)d,其中内镜下鼻肠管肠内营养可促进患者恢复,恢复时间缩短为(7.00±1.10)d,差异有统计学意义。结论远端胃大部份切除术后胃瘫与多种因素有关。保守治疗有效,其中鼻肠管肠内营养效果良好,可显著促进患者恢复。Objective To investigate etiology,prevention and treatment of postsurgical gastroparesis syndrome(PGS) after distal subtotal gastrectomy,and analyze its risk factors and compare efficacy of different treatment methods.Methods Clinical data of 492 patients with distal subtotal gastrectomy,including 22 patients complicated with PGS,were analyzed restrospectively.Single factor Chi-square test and multi-factor Logistic regression analysis were used to determine the risk factors for PGS.Results The incidence of PGS was 4.5%(22/492).Single factor Chi-square test revealed that perioperative hyperglycemia,preoperative malnutrition,anxiety,preoperative pyloric obstruction,Billroth Ⅱ gastrointestinal reconstruction,anastomotic fistula,and vagal trunks cut-off were correlated with PGS.Multi-factor Logistic regression analysis revealed that preoperative pyloric obstruction,anxiety,Billroth Ⅱ gastrointestinal reconstruction and anastomotic fistula were main risk factors for PGS.All patients were healed through conservative treatments,and the mean recovery time was(13.05±7.79)d.Eleven patients received enteral nutrition through naso-intestinal tube with endoscopic guidance,and the mean recovery time of the patients decreased significantly to(7.00±1.10)d.Conclusions Postsurgical gastroparesis syndrome after distal subtotal gastrectomy was correlated with many clinicopathological factors.Conservative treatments are effective and especially enteral nutrition through naso-intestinal tube with endoscopic guidance is most effective,which can improve such patients' recovery.

关 键 词：胃瘫综合征 胃大部分切除术 危险因素 治疗 

分 类 号：R656.6[医药卫生—外科学]