胃癌根治术后胃瘫综合征的临床诊断

Diagnosis and Clinical Analysis of Postsurgical Gastroparesis Syndrome after Radical Operation of Gastric Carcinoma

目的探讨胃癌根治切除术后胃轻瘫综合征(postsurgical gastroparesis syndrome,PGS)的病因、诊断及治疗方法。方法回顾性分析作者医院2006/2012年行择期胃癌根治术的612例患者资料,将年龄、性别、手术方式(毕Ⅰ/毕Ⅱ)、体质量指数(body mass index,BMI)、TNM分期、肿瘤大小、伴糖尿病、伴神经系统疾病、围手术期精神药物使用,作为临床相关因素,采用Logistic多因素回归分析确定PGS的分布与临床因素之间的相关性;患者治疗前后采用总症状评分(total symptom score,TSS)比较。结果 612例中有41例出现PGS表现,发生率为6.7%。患者症状主要为恶心,呕吐,腹胀,早饱,腹痛。胃镜检查能顺利通过吻合口,未见机械性梗阻征象。核素标记餐(99 Tcm-DTPA标记混合餐)胃排空显像证实胃排空延迟,性别、伴糖尿病、伴神经系统疾病以及精神药物使用与PGS显著相关。所有患者经保守治疗后均治愈。结论术后胃轻瘫由多因素导致,胃镜检查与胃肠道造影是重要的诊断方法。

Objective To explore the etiology, diagnosis and treatment of postsurgical gastroparesis syndrome （PGS） after radical gastrectomy of gastric carcinoma. Methods The medical records of 612 patients who received radical gastrectomy for gastric carcinoma in our hospital were retrospectively analyzed. The clinical factors including age, gen- der, surgical approach, body mass index （BMI）, TNM stage, tumor size, complicated with diabetes or nervous system disease, perioperative psychotropic medications were considered as the potential PGS-related factors. A standard total symptom score （TSS） was determined for all patients before and after treatment. Results PGS occurred in 41 patients （6. 7%） among 612 patients. The main symptoms included nausea, vomiting, bloating, early satiety, and abdominal pain. The gastroscopy could be stretched into the duodenum through anastomotic stoma, and signs of mechanical obstruc- tion were not found. Gastric-emptying scintigraphy （GES） confirmed the delayed gastric emptying. Gender, surgical ap- proach, complicated with diabetes or nervous system disease, perioperative psychotropic medication were significantly as- sociated with PGS. All patients were cured by conservative treatment. Conclusion PGS is caused by multiple pathogene- sis factors. Endoscopy and GES are important diagnosis methods.