胃癌根治术后功能性胃排空障碍的治疗及相关危险因素分析  

Therapeutic and risk factors analysis of functional delayed gastric emptying after gastric carcinoma sur-gery

作　　者：金炜东[1] 蔡逊[1] 马丹丹[1] 张建新[1] 蔡雄[1] 

机构地区：[1]广州军区武汉总医院普通外科,武汉430070

出　　处：《腹部外科》2015年第4期254-257,共4页Journal of Abdominal Surgery

基　　金：湖北省自然科学基金（No.2011CDB021）;武汉市科技计划项目（基金编号：No.2013062301010821）

摘　　要：目的：探讨胃癌根治术后功能性胃排空障碍的危险因素、诊断和治疗。方法对2010年1月至2014年12月期间收治的508例接受胃癌根治术的病人资料进行回顾性分析（（排除行全胃切除及 Roux-en-Y 吻合的病人）。结果508例病人中共观察到25例（4.9%）发生功能性胃排空障碍（functional delayed gastricemptying,FDGE）。FDGE 的发生与病人的性别、年龄、贫血、术中出血量、根治范围、术后首次排气时间、术后是否使用镇痛泵无关（P〉0.05）。多因素分析显示：手术时间、焦虑、手术方式、术中是否保留迷走神经干、围手术期低白蛋白血症、术后高血糖症、术后腹腔感染为影响 FDGE 发生的危险因素（P〈0.05）。结论对于手术时间长、出现围手术期低蛋白、术后高血糖、术后腹腔感染或者行毕Ⅱ术式、未保留迷走神经干的病人应注意预防 FDGE 的发生,减轻病人的焦虑状态有助于预防该疾病的发生。Objective To investigate the risk factors,diagnosis and therapeutic of functional de-layed gastric emptying （FDGE）after gastric carcinoma surgery.Methods The clinical data of 508 pa-tients with gastric carcinoma between January 2010 and December 2014 were retrospectively analyzed. The patients with total gastrectomy resection and Roux-en-Y anastomosis were excluded.Results 25 cases of FDGE were found in all cases,the incidence rate was 4.9%.The differences of FDGE in gen-der,age,anemia,blood loss in surgery,the radical extension,initial exhaust time,usage of analgesia had no statistical significance（P〉0.05）.Multivariate analysis results showed that operation time,the anxiety,billroth Ⅱ surgery,reservation of vagus nerve,perioperative hypoglycemia,postoperative hyperglycemia,intra-abdominal infection were the risk factors for FDGE （P〈0.05 ）.Conclusions Long time of operation,perioperative hypoglycemia,postoperative hyperglycemia,intra-abdominal in-fection,reservation of vagus nerve,and billroth Ⅱ surgery should easily result in FDGE.Moreover, reduction of patient anxiety may contribute to prevent this disease.

关 键 词：胃肿瘤 功能性胃排空障碍 治疗 危险因素 

分 类 号：R656.6[医药卫生—外科学]