横结肠癌术后胃排空延迟的诊断和防治  

Delayed gastric emptying after surgery for transverse colon cancer:diagnosis,management and prevention

作　　者：池畔[1] 黄胜辉[1] Chi Pan;Huang Shenghui(Department of Colorectal Surgery,Union Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院结直肠外科,福州350001

出　　处：《中华胃肠外科杂志》2022年第6期493-499,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：福建省微创医学中心建设项目(闽卫医政函[2017]171号);福建省科技创新联合资金(2017Y9038、2019Y9101)。

摘　　要：胃排空延迟是一种在排除肠梗阻、吻合口狭窄等机械性因素的前提下,以胃排空迟缓为主要征象的胃动力紊乱综合征。结肠癌术后胃排空延迟的发生率为1.4%,以横结肠癌术后为主,多数为病例报道,缺乏系统研究。其诊断和治疗多数借鉴胰腺手术后胃排空延迟的经验。笔者中心回顾性研究表明,横结肠癌术后胃排空延迟发生率高于其他部位结肠癌手术,为4.0%,网膜弓淋巴结清扫高于未清扫组(3.6%比0.8%)。网膜弓清扫和应激是横结肠癌术后胃排空延迟的危险因素。国际胰腺外科小组诊断标准加上泛影葡胺胃造影,用于诊断横结肠术后胃排空延迟更简单实用。胃肠减压、肠内联合肠外营养、激素、促胃动力药等可治愈多数术后胃排空延迟。严格掌握网膜弓清扫的适应证(选择cT3~4与cN+),有望减少横结肠癌术后胃排空延迟的发生。Delayed gastric emptying is a syndrome of gastric motility disorder with slow gastric emptying as the main sign,provided that mechanical factors such as intestinal obstruction and anastomotic stricture are excluded.The incidence of delayed gastric emptying after colon cancer surgery is 1.4%,mainly after transverse colon cancer surgery.Most of the studies on delayed gastric emptying are case reports,lacking systematic studies.The diagnoses and treatments can be draw on the experience of delayed gastric emptying after pancreatic surgery.Our retrospective study indicated that the incidence of delayed gastric emptying after surgery for transverse colon cancer was 4.0%,higher than that for other colon cancer.Patients who underwent gastrocolic ligament lymph node dissection were at higher risk than those who did not(3.6%vs.0.8%).Gastrocolic ligament lymph node dissection and stress are causative factors for delayed gastric emptying after surgery for transverse colon cancer.We add the gastrografin test upon the diagnostic criteria of the International Study Group for Pancreatic Surgery,which is simple and practical.Nasogastric tube decompression,enteral nutrition combined with parenteral nutrition,glucocorticoids,and prokinetic agents can cure most patients with postoperative delayed gastric emptying.All the patients with postoperative delayed gastric emptying were cured in our studies.Strict indications for gastrocolic ligament lymph node dissection(patients with cT3-4 and cN+)may decrease the occurrence of delayed gastric emptying after surgery for transverse colon cancer.

关 键 词：胃排空延迟 横结肠肿瘤 胃结肠韧带 幽门下淋巴结 

分 类 号：R735.34[医药卫生—肿瘤]