贲门癌切除术后残胃排空功能变化

Gastric emptying after proximal subtotal gastrectomy for cardiac cancer

目的观察贲门癌术后残胃排空功能变化，探讨改善病人术后生活质量的方法。方法用豆奶粉４０ｇ，水２００ｍＬ，加入１８５ＭＢｑ９９ＴｃｍＤＴＰＡ，制成试验餐，于术后１８～２０ｄ对２５例行贲门癌近端胃次全切除患者［附加幽门括约肌捏断１７例（Ａ组），单纯近端胃次全切除８例（Ｂ组）］和５例健康人（Ｎ组）进行核素胃排空检查。结果口服试验餐后１０５ｍｉｎ之内，每一时刻的胃排空率Ｂ组均低于Ａ组（Ｐ均＜００１）和Ｎ组（Ｐ均＜００５），而Ａ组与Ｎ组差异无显著性（Ｐ均＞００５）。Ｂ组的半量胃排空时间为（６１５±７０）ｍｉｎ，较Ａ组（２５６±５６）ｍｉｎ（Ｐ＝０００１３）和Ｎ组（３３６±６１）ｍｉｎ（Ｐ＝００２６）明显延长，而Ａ组的半量胃排空时间与Ｎ组差异无显著性（Ｐ＞００５）。结论贲门癌行近端胃次全切除术后，残胃排空延缓，若附加幽门括约肌捏断术，则明显加快残胃排空，改善术后症状。

Objective To assess emptying of the remaining stomach after proximalsubtotal gastrectomy for cardiac cancer, and to explore a method improving the life quality of postoperative patients Methods Radionuclide gastric emptying test was performed on 17 patients who underwent proximal subtotal gastrectomy plus disruption of pyloric sphincter (PSG+DPS) by manipulative nipping and on 8 patients who underwent proximal subtotal gastrectomy (PSG) only 18 to 20 d before, and on 5 normal controls Test meal was prepared from the mixture of soybean milk powder (40 g), water (200 mL) and 99 TcmDTPA (185 MBq) as a tracer Results During the first 105 min after ingestion of test meal, gastric emptying rate at each time was lower in PSG group than those in PSG+DPS group ( P <001) and normal controls ( P <005) However, the gastric emptying rate did not show significant difference between PSG+DPS group and normal controls ( P >005) The time required for the stomach to empty half of its radioactive content (T1/2) was longer in the patients who had PSG only than that in those who underwent PSG+DPS , ( P =00013) and normal controls 3661) min], ( P =0026) However, there was no significant difference regarding T1/2 between the patients with PSG+DPS and normal controls ( P >005) Conclusions Proximal subtotal gastrectomy inevitably delays the emptying of remaining stomach, and DPS can effectively accelerate its emptying and improve postoperative symptoms