腹部非胃手术后胃瘫综合征的综合治疗:19例临床分析

Comprehensive Management of Postsurgical Gastroparesis Syndrome after Non-gastric Abdominal Operation:Clinical Analysis of 19 Cases

背景:术后胃瘫综合征是一种以胃排空延迟为特征的功能性疾病,多见于胃部手术后,继发于腹部其他脏器术后者少见。目的:探讨腹部非胃手术后胃瘫综合征的发病机制和有效治疗方法。方法:回顾性分析上海仁济医院普外科1998年5月～2008年4月腹部非胃手术后胃瘫综合征患者的临床表现、治疗方法和治疗结果。结果:共19例患者纳入研究。腹部非胃手术后胃瘫综合征多发生于手术时间长、手术创伤较大的患者,主要临床表现为术后3～5 d进食后出现上腹饱胀、呕吐,再次胃肠减压时引流量>800 ml/d。胃碘水造影和胃镜检查可提供诊断依据。胃肠减压、促胃动力、营养支持和中医(中药和针灸)综合治疗有助于胃动力的恢复。结论:腹部非胃手术后胃瘫综合征的发生可能是多因素综合作用的结果,非手术综合治疗可获得较好疗效。

Background： Postsurgical gastroparesis syndrome （PGS） is a functional disorder characterized by delayed gastric emptying, which is frequently seen after gastric operation but seldom after non-gastric abdominal operation. Aims： To investigate the mechanism and effective treatment of PGS after non-gastric abdominal operation. Methods： The clinical data of inpatients undergoing non-gastric abdominal operation and having PGS in the Department of General Surgery, Renji Hospital from May 1998 to April 2008 were analyzed retrospectively, including clinical manifestations, treatment and clinical outcome. Results： Nineteen patients were enrolled in this study. PGS was more frequent in patients undergoing longer duration of operation and more operative trauma, mainly manifested by upper abdominal distention, vomiting and large volume of gastric drainage （〉800 ml/d） after postoperative oral feeding. Gastrography with iodinated water and gastroscopy were valuable in the diagnosis of PGS. Comprehensive management with gastrointestinal decompression, prokinetics, nutritional support, traditional Chinese medicine and acupuncture was helpful for the recovery of stomach kinetics. Conclusions： Multi-factors are involved in the pathogenesis of PGS after non-gastric abdominal operation and nonsurgical comprehensive therapy is effective for its treatment.