胃大部切除术后残胃无力症的诊断治疗

Treatment and diagnosis of functional gastric atony after subtotal gastrectomy

目的探讨胃大部切除术后功能性残胃无力症的诊断方法与治疗措施,避免误诊误治。方法对1988-08～2004-02收治的29例胃大部切除术后功能性残胃无力症的临床表现、诊断方法与治疗结果进行回顾性分析。结果全组患者经立位腹部X线平片检查、泛影葡胺或稀钡X线透视检查、或纤维胃镜检查,结果均排除机械性梗阻的原因,诊断为:功能性残胃无力症。经过胃肠减压、胃肠外营养、对症治疗,分别治疗16～49d症状消失,恢复饮食。结论胃大部切除术后功能性残胃无力症是非机械性梗阻,由多种因素引起,高龄、精神紧张为主要诱发原因,依据临床症状、X线检查和胃镜检查明确诊断,目前尚无治疗该症的特效药物,治疗原则以消除患者的紧张情绪和对症、支持治疗为主,避免手术治疗,保守治疗效果较好。

Objective To explore treatment and diagnosis of gastric atony after subtotal gastrectomy so as to avoid the erroneous diagnosis and mistreatment. Methods The results, methods of treatment and diagnosis and clinical manifestations in 29 cases of gastric atony after subtotal gastrectomy from August, 1988 to February, 2004 were analysed retrospectively. Results All the cases were diagnosed by symptom and iodine or barium studies or endoscopy, as functional gastric atony, except for mechanical obstruction. All the cases healed after treated for sixteen to forty-nine days with convention and particular of treatment. Conclusions Functional gastric atony after subtotal gastrectomy belongs to non-mechanical obstruction of intestine. The result from the compound factor, the psychic factor and the advanced age may be the two main factors. The symptom, X-ray and endoscopy could be useful for diagnosis. No medicine were found to cure the disease effectively. Eliminating the patient's nervous stress and giving nutrition support may be effective treatment.The operation treatment should be avoided.