食管 贲门癌术后胃瘫32例临床诊治体会

Thoughts on diagnosis and treatment of 32 cases of post-surgery subtotal gastroparesis on gastrectomy and esophagectomy cancer patients

目的总结食管、贲门癌术后胃瘫临床诊治经验。方法对1991年至2007年食管癌、贲门癌术后发生胃瘫的32例患者的治疗过程和效果进行回顾性分析。结果所有患者主要表现为胃潴留,无明显腹痛,肛门排气大多正常。消化道造影可见胃蠕动差,吻合口通畅。CT显示胸腔胃明显增大以及大量胃液潴留。本组病例中1例患者死于绿脓杆菌性肺炎。其余所有病例经胃肠减压,肠内营养支持,维持水电解质平衡,以及用促进胃肠动力药物的应用等措施使病情均得以缓解出院。结论食管癌、贲门癌术后胃瘫的诊断主要依据临床表现、消化道造影及胸CT等检查。排除机械性梗阻的存在后应积极采取肠内营养及胃肠动力促进剂等综合治疗,可以治愈。

Objective To review the diagnosis and treatment of gastroparesis after esophagectomy. Methods Retrospectively analyzed 32 cases of clinical data between 1991 and 2007 with post-surgery subtotal Gastroparesis on gastrectomy ＆ esophagectomy patients. Results Gastroparesis in these patients caused the undesirable symploms of nausea, vomiting, abdominal pain, bloating and early satiety and there is lcase of death due to Pseudomonas aeruginosa pneumonia. The upper gastrointestinal radiography showed a decrease in gastric motility, and no stomach obstruction. The rest of the cases had curative effects through the reduction of gastric pressure, maintenance of hydro electrolytic balance and nutritional supplement, and application of prokinetic drugs. Conclusion The diagnosis of gastroparesis mainly depends on the clinical appearances, chest CT Scan and GI. When the gastroparesis is confirmed, the patient should be treated with conservative methods, such as the application of internal nutrition, prokinetic agents.