胰十二指肠切除术后胃瘫的诊断和治疗探讨

THE DIAGNOSIS AND THERAPY OF GASTROPARESIS AFTER PANCREATICODUODENECTOMY

目的探讨胰十二指肠切除术后胃瘫(PGS)的诊断、鉴别诊断和治疗方法。方法回顾性分析8例胰十二指肠切除术后PGS病人的临床资料。本组所有病人胰十二指肠切除术消化道重建均采用Child法,术后留置胃管、鼻肠管。PGS发生于术后的5～12d,通过术后临床表现、泛影葡胺上消化道造影及胃镜检查证实诊断。所有病人均行非手术治疗,予持续胃肠减压,分阶段营养支持,改善胃动力等保守治疗。结果8例中2例于2周内恢复,3例于4周内恢复,3例于6周内恢复,最长1例40d恢复,平均病程25.8d。所有病人均治愈,无再次手术病人。结论PGS是胰十二指肠切除术后的常见并发症,结合临床表现以及辅助检查结果不难做出诊断。应采取积极保守治疗,包括分阶段营养支持、改善胃肠动力等,避免再次手术。

Objective To study the diagnosis, differential diagnosis and treatment of postoperative gastroparesis syndrome （PGS） after panereatieoduodenectomy （PDE）. Methods Clinical data of eight patients with PGS after PDE were analyzed retrospectively. All the patients received the Child digestive tract restitution with a gastric and a nasointestinal tube indwelled after surgery. PGS occurred 5-12 days after operation, which was confirmed by clinical manifestation, digestive tract opacification and gastroscopy. Nonoperative therapy, including continued gastrointestinal decompression, grading nutrition support and stomach dynamic improvement, was offered. Results Two patients recovered within two weeks, three within four weeks, and three within six weeks, the longest time was 40 days in one patient. No secondary surgery was needed. Conclusion PGS is a commonly seen complication after PDE, its diagnosis is easy to make based on clinical manifestations and auxiliary examinations. Active nonoperative therapy as mentioned above should be adopted to avoid re-operation.