胃癌根治性远端胃切除术后胃瘫危险因素分析  

Risk factors of gastroparesis after radical gastrectomyfor distal gastric cancer

作　　者：宋承鹏[1] 吴斌[1] 朱俊[1] 李栋梁[1] 吴申伟[1] 谢贻祥[1] 

机构地区：[1]安徽医科大学附属六安医院普外科

出　　处：《临床外科杂志》2015年第10期747-749,共3页Journal of Clinical Surgery

摘　　要：目的分析胃癌根治性远端胃切除术后胃瘫发生的危险因素，为降低胃癌根治术后胃瘫发生率提供临床参考。方法胃癌根治性远端胃切除术患者254例（其中腹腔镜手术66例），采用单因素和多因素分析方法筛选术后胃瘫的独立危险因素。结果254例患者术后发生胃瘫9例，发生率为3．5％（9／254）。术前糖尿病病史、低白蛋白血症、合并幽门梗阻、毕Ⅱ式吻合和术后使用镇痛泵为根治性远端胃切除术后胃瘫的危险因素（均P〈0．05），二分类Logistic回归方程筛选得出术前糖尿病病史、术前合并幽门梗阻、毕Ⅱ式吻合为术后胃瘫发生的独立危险因素（均P〈0．05）。结论术前糖尿病病史、术前合并幽门梗阻、毕Ⅱ式吻合为术后胃瘫发生的独立危险因素。围术期对患者良好的血糖管理，术前留置胃管、营养支持以改善幽门梗阻症状，以及合理的消化道重建，可降低术后胃瘫发生率。Objective To investigate the risk factors of gastroparesis afterradical gastrectomyfor distal gastric cancer andprovide clinical guidance for reducing its incidence. Methods The clinical data of 254 cases of radical gastrectomy for distal gastric cancer, including 66 cases of laparoscopic surgery, were reviewed retrospectively. Independent risk factorsof postoperative gastroparesis were screened by uni- variate and multivariate statistical analysis. Results The incidence of postoperative gastroparesis was 3.5% （9/254）. Preoperative historyof diabetes, preoperative hypoalbuminemia, preoperative pyloric ob- struction, Billroth l/ anastomosis, and postoperativeanalgesia pumpingwere the riskfactors of gastroparesis （ all P 〈 0.05 ）. Binary logistic regression showed that preoperative history of diabetes, preoperative pyloric obstruction, and Billroth II anastomosis wereindependent risk factors of postoperative gastroparesis （all P 〈0. 05）. Conclusion Preoperative history of diabetes, preoperative pyloric obstruction, Billroth Ⅱ anastomosis are the independent risk factors for postoperative gastroparesis. But managing preoperative blood glucose, improving pyloric obstruction by indwelling gastric tube and nutritional support, andreasonable re- construction of the digestive tractcan reduce the incidence of postoperative gastric paralysis.

关 键 词：胃癌 根治性远端胃切除术 胃瘫 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]