食管癌术后胃瘫综合征23例诊治的探讨

Diagnosis and treatment of gastroparesis syndrome after esophagogastrectomy of esophageal cancer

目的探讨食管癌术后胃瘫综合征的诊断与治疗经验。方法回顾性分析本院2002～2010年诊治23例食管癌术后胃瘫综合征患者的临床资料。结果 23例患者均行纤维胃镜检查排除机械性梗阻,并常规行胃镜下幽门扩张和十二指肠营养管置入,经胃肠减压、营养支持和促胃动力药物及中医中药等非手术治疗,平均18.7d后胃肠功能恢复;合并肺部感染2例,颈部吻合口瘘1例,无死亡病例。结论食管癌术后常规上消化道造影有利于早期发现胃瘫综合征,其诊断须胃镜检查除外机械性梗阻;治疗关键在于胃镜下幽门扩张和肠内营养支持,非手术治疗效果满意。

Objective To explore the diagnosis and treatment experience of gastroparesis syndrome after esophagogastrectomy of esophageal caneer（GSEEC）. Methods The clinical data of 23 patients with GSEEC from 2002 to 2010 were analyzed retrospectively. Results All patients under took fibrogastroscopy to ruled out mechanical obstruction,and treated conservatively by routine fibrogastroscopy-assisted pyloric dilatation and duodenal feeding tube placement, gastrointestinal decompression, nutritional sup- port, prokinetic drugs and chinese medicine. Recovery of gastrointestinal function were achieved on an average period of 18.7 days, 2 patients were accompanied with pulmonary infection, 1 patient was accompanied with cervical anastomotic fistula, and no case of death was observed. Conclusion Routine radiography of upper gastrointestinal tract contribute to early diagnosis of GSEEC,me- chanical obstruction must be excluded firstly by gastroscopy; The key treatments of GSEEC are fibrogastroscopy-assisted pyloric dilatation and enteral nutrition support. Clinical result of conservative treatment is satisfactory.