胃三维容积测定对评估术后胃轻瘫患者G-POEM手术疗效的价值  

Measurement of Gastric Volume by Three-dimensional Ultrasound in Evaluating Efficacy of G-POEM Surgery of Patients with Postoperative Gastroparesis

作　　者：卢延嘉 胡中倩[1] 黄岩[2] 韩煜东 李嘉[1] 谭佳成 LU Yanjia;HU Zhongqian;HUANG Yan;HAN Yudong;LI Jia;TAN Jiacheng(Department of Ultrasound,Zhongda Hospital Affiliated Southeast University,Nanjing 210009,China;不详)

机构地区：[1]东南大学附属中大医院超声诊断科,江苏南京210009 [2]南京中医药大学,南京市中医院超声科,江苏南京210001 [3]南京医科大学附属南京医院,南京市第一医院超声医学科,江苏南京210006 [4]东南大学附属中大医院消化科,江苏南京210009

出　　处：《中国医学影像学杂志》2019年第10期783-787,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨术后胃轻瘫患者行经口内镜下胃幽门环肌切开术(G-POEM)前后超声胃三维容积的测定与临床症状评分的相关性,进而判断超声胃三维容积测定评价G-POEM手术疗效的价值。资料与方法选择确诊为术后胃轻瘫,且需行G-POEM手术的20例患者。分别于G-POEM手术前后进行胃瘫主要症状指数(GCSI)评分;同期所有患者空腹8~12 h后口服造影剂200 ml,并分别在口服造影剂后5 min、15 min、25 min、40 min、55 min、70 min及90 min测定胃容积。上述不同时间点测量胃容积的方法分别在G-POEM手术前后各测量1次。分析手术前后同一时间点的胃容积差值与G-POEM手术前后GCSI评分差值的相关性。结果20例患者G-POEM手术前GCSI评分2.34~4.91分,平均(3.29±0.77)分;术后GCSI评分0.50~2.20分,平均(1.38±0.52)分。本组患者术后GCSI评分较术前显著改善,差异有统计学意义(t=10.135,P=0.000)。超声胃三维容积显示,16例患者胃排空时间较术前明显减少(Z=-3.536,P=0.000);4例患者在所测时间范围内胃未排空,但胃容积较术前明显减少。5 min、15 min、25 min、70 min时间点手术前后胃容积差值与临床症状评分差值均呈中度正相关(r=0.497、0.640、0.674、0.519,P<0.05);40 min与55 min时间点手术前后胃容积差值与临床症状评分差值均呈高度正相关(r=0.767、0.770,P<0.05);90 min时间点手术前后胃容积差值与临床症状评分差值无相关性(r=0.215,P>0.05)。结论对于胃部分切除患者,腹腔胃超声三维容积测定与G-POEM手术前后的临床症状改善存在一定的相关性,可作为临床G-POEM手术疗效的评价方法。Purpose To investigate the correlation between the measurement of gastric volume by three-dimensional ultrasound and clinical symptom scores before and after gastric peroral endoscopic pyloromyotomy(G-POEM)surgery in patients with postoperative gastroparesis,and to judge the value of measurement of gastric volume by three-dimensional ultrasound in the evaluation of the efficacy of G-POEM surgery.Materials and Methods Twenty patients diagnosed with postoperative gastroparesis and underwent G-POEM surgery were selected.The clinical symptoms were scored before and after G-POEM surgery.All patients were given 200 ml contrast medium orally after 8-12 hours of fasting,and the gastric volume was measured at 5 min,15 min,25 min,40 min,55 min,70 min and 90 min after oral intake of contrast medium,respectively.The volume was measured before and after G-POEM surgery using the gastric volume measurement method at the different time points.The difference between the gastric volume at the same time point before and after the surgery and the difference between the clinical symptom scores before and after the G-POEM surgery were analyzed.Results The clinical symptom scores of 20 patients after G-POEM surgery were improved compared with those before surgery(t=10.135,P=0.000).The preoperative score was 2.34-4.91 points,with an average of(3.29±0.77)points,the postoperative score was 0.50-2.20 points,with an average of(1.38±0.52)points.The gastric volume by the three-dimensional ultrasound showed that 16 patients in this group had significantly faster gastric emptying time than before surgery(Z=-3.536,P=0.000).The other 4 patients did not empty the stomach within the measured time,however,the gastric volume was significantly reduced compared with preoperative volume.The difference between gastric volumes before and after surgery and difference between clinical symptom scores at 5 min,15 min,25 min,70 min time point(r=0.497,0.640,0.674,0.519,P<0.05)showed moderate positive correlation,those at 40 min and 55 min time point(r=0.767,0

关 键 词：胃肌轻瘫 胃镜检查 超声检查 造影剂 治疗结果 手术前期间 手术后期间 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.2[医药卫生—诊断学]