胰腺癌冷冻和胰十二指肠切除术后胃瘫综合征多因素分析及护理

Multivariate analysis and nursing care of gastroparesis sundrome after pancreatic cancer cryotherapy and pancreatico-duodenectomy

目的分析胰腺癌冷冻和胰十二指肠切除术后所致胃瘫综合征(PGS)与多因素的相关性,探讨其发生机制、诊治措施并总结护理经验提高护理质量。方法对我院所行的胰十二指肠切除术210例患者和行胰腺癌冷冻术46例患者的临床和护理资料进行回顾性的统计分析。结果在B组患者(胰腺癌冷冻术组)中有31例(67%,31/46)患者出现了PGS,其中有29例肿瘤位于胰头和钩突部,2例肿瘤位于体尾部。在A组中(胰十二指肠切除术组)有10例(4.8%,10/210)患者出现了PGS。B组的胃瘫发生率明显高于A组(χ2=145,P<0.001)。A组PGS患者有9例采用非手术治疗(饮食调节、药物、心理护理、胃液引流等)而痊愈;B组PGS患者均采用非手术治疗痊愈。胰腺癌冷冻所致PGS同冷冻术、胰腺肿瘤的位置有密切的相关性,但同年龄、性别、低蛋白血症、梗阻性黄疸、术前胃输出道梗阻,以及胃、胆管所行的手术方式和次数均无明显相关性。绝大部分PGS患者经胃液引流、加强护理措施和心理辅导、适当药物治疗和营养支持都能治愈。结论胰腺癌冷冻可引起胃瘫,胰腺癌冷冻和胰十二指肠切除术后PGS由多种原因引起,其确切机制不清。心理护理、有效胃肠减压、中西医结合治疗、加强营养支持后是促进胃肠功能恢复的关键。

Objective To explore the etiology,nursing care and treatment,and to conclude the nursing experience with postsurgical gastroparesis syndrome （PGS） after pancreatic cancer cryotherapy （PCC） and panereatico-duodenectomy （ PD）, and to analyze the correlation between the multiple factors and laGS caused by PCC. Methods Clinical data of 210 patients underg-one PD and 46 patients undergone PCC were analyzed retrospectively. Results There were 31 （67% ,31/46） patients suffering from PGS in the group B-patients who underwent cryotherapy,including 29 with head and uncinate tumors and two with body and tail tumors. There were ten（4.8%, 10/210）patients suffering from PGS in the group A-patients who underwent pancreatico-duodenectomy. The incidence of PGS after PCC（67% ） was significantly higher than that after PD（4.8% ）. （ χ^2 = 145 ,P〈0.001 ）. In the group A, nine patients with PGS were managed with non-operative treatment （drugs, diet, nasogastric suction, etc）, and one patient was performed reoperation at 16th day,but symptoms were not relieved. However, in the group B, all of the patients with PGS were managed with non-operative treatment. Conclusion The PGS after PCC and PD is induced by multiple factors and is indefinite about the exact mechanisms. The methods of non-operative treatment are effective to patients with PGS, and operation should be considered as contraindieation for patients with PGS caused by PCC. The nursing key was to observe carefully the drain of nasogastfie suction ,to stress the mentality drugs and die nursing.