胃大部切除术后残胃无张力症的诊治体会

Experience in Diagnosis and Treatment of Tension-free Gastric Disease after Subtotal Gastectomy

目的探讨胃大部切除术后残胃无张力症(胃排空障碍)的原因、诊断与治疗。方法分析我院外科1990～2007年32例胃大部切除术后残胃排空障碍的诊疗经过。结果残胃排空障碍发生于术后4～8d,27例经保守治疗治愈。保守治疗时间8～24d,平均13d。5例因保守治疗无望而中转手术,术中发现残胃排空障碍均与粘连有关,其中4例是与大网膜粘连团块压迫吻合口与输出段空肠有关。结论胃大部切除术后并发残胃排空障碍多数是功能性的,可经保守治疗治愈,但若经3w以上保守治疗仍未奏效者,应考虑机械性梗阻的存在。胃钡餐(GI)与胃镜检查有助于明确诊断,应尽早中转手术。

Objective To investigate the reason,diagnosis and treatment of tension-free gastric disease after subtotal gastrectomy （delayed gastric emptying）. Methods To analyze the diagnosis and treatment of 32 cases gastric remnant after resection of gastric emptying in our surgery department from 1990 to 2007. Results Residual postoperative delayed gastric emptying occurred in 4- 8d; 27 patients were cured with conservative treatment of 8-24d,13d on average;5 cases of hopelessness were transmitted to conservative treatment surgery and their residues found delayed gastric emptying were related to adhesion,and four cases of omental adhesions and mass oppression anastomotic jejunum were related to output the relevant paragraph. Conclusion Subtotal gastrectomy complicated by delayed gastric emptying residue are functional most of the time,which can be cured by conservative treatment,but if it not yet effective after more than 3 weeks of conservative treatment,the existence of mechanical obstruction should he taken into account,and stomach barium meal（GI） and gastroscopy help diagnosis clearly. Transit operations should be carried out as early as possible.