胃切除术后残胃胃瘫综合征的临床总结

Clinical analysis of postsurgical gastroparesis syndrome after gastrectomy

目的探讨胃大部切除术后残胃胃瘫综合征(PGS)的发生原因、机制、诊断及治疗。方法对1972年1月至2002年6月4955例胃大部切除术后出现PGS的46例患者的临床资料进行回顾性总结。结果本组PGS发生率0.92%,均发生于术后5～8d。44例非手术治愈,15d内治愈12例,16d10例,18d15例,21d2例,22d2例,25d2例,27d1例。2例于胃大部切除术后14d和15d再次手术加行胃肠或肠肠吻合仍未缓解,继续内科治疗,分别于术后20d和30d治愈。结论PGS的发生是由多种因素诱发。诊断时必须排除机械性、器质性病变。上消化道造影及胃镜检查是诊断PGS的可靠方法。采用非手术疗法均可治愈,手术治疗应列为禁忌证。

Objective To explore the etiology,pathogenesis,diagnosis and treatment of postsurgical gastroparesis syndrome(PGS) after subtotal gastrectomy. Methods Clinical data of 4 955 patients with subtotal gastrectomy (from 1972 1 to 2002.2) were analyzed retrospectively. Results There were 46 patients suffering from PGS (0 92% in total 4 955 patients), occurring within 5～8 d after operation. 44 patients were cured with nonoperative treatment(within 15 d:12; 16 d:10; 18 d:15; 21 d:2; 22 d:2; 25 d:2; 27 d:1). Reoperation was performed in two patients at 14th d and 16th d respectively, but symptoms were not relieved. They all pulled through with sustaining nonoperative treatments at 20th d and 30th d after operation. Conclusions PGS is induced by multiple factors. Radiography of upper gastrointestinal tract and gastroscopy are main methods to diagnose PGS, and organic and mechanical illness must be excluded. The methods of nonoperation are effective to patients with PGS, and operation should be classed as contraindication.