术后功能性胃排空障碍的诊断和治疗25例临床分析

Diagnosis and treatment of postoperative gastroparesis:report of 25 cases

目的 探讨腹部术后功能性胃排空障碍 (胃瘫 )的临床诊断及治疗方法。方法 对西南医院临床诊治 2 5例施行腹部手术后发生术后胃瘫病人的外科疾病、临床表现、诊断方法、治疗手段进行回顾性分析。结果 术前长期流出道梗阻或恶性肿瘤的病人 ,行不伴胃切除的胃空肠吻合术、胰十二指肠切除术后胃瘫的发病率较高 ;诊断方法主要依靠胃镜、上消化道造影及核素胃排空试验 ;经肠外营养支持为主的保守治疗后 18例 (72 % )胃肠动力在术后 4周内恢复 ,2 2例 (88% )术后 5周内恢复 ,2例 (8% )在手术 7周后恢复者均为再次手术的病人。结论 采用肠外营养联合促胃肠动力药物的保守支持治疗是治疗术后胃瘫的有关手段 ,应避免再手术。

Objective To investigate the diagnosis and treatment of gastroparesis after abdominal surgery.Methods Undergoing surgical entities,clinical manifestations,diagnostic methods and therapeutic approaches of 25 cases of postoperative gastroparesis admitted in Southwest Hospital were analyzed retrospectively.Results Postoperative gastroparesis occurred frequently in those patients who having a long standing preoperative gastric outlet obstruction or malignant pathology,especially after performing the simple gastrojejunostomy without gastric resection or pancreatico duodenectomy.Endoscopy,upper gastrointestinal radiography and radioisotope scintigraphy were effective methods in the diagnosis of postoperative gastroparesis.Eighteen cases(72%) in 4 week,and 22 case(88%) in 5 week after operation had achieved normal gastrointestinal movement by total parenteral nutrition(TPN) together with prokinetic drugs.Two patients(8%) recovered after 7 weeks were both performed reoperation.Conclusion Postoperative gastroparesis can recover spontaneously after a longer period of supportive treatment by TPN combined with prokinetic drugs,and second surgery should be avoided.