腹部非胃手术后功能性胃排空障碍的诊治分析

Diagnosis and treatment of functional delayed gastric emptying after nongastric abdominal surgery

目的：探讨腹部非胃手术后功能性胃排空障碍的病因、发病机制、诊断、治疗和预防方法。方法：回顾性分析我院2011年8月至2012年8月间诊治的8例腹部非胃手术后功能性胃排空障碍病人的临床资料。结果：8例病人平均年龄为（69．9±11．2）岁，均为开腹手术。6例（75．0％）有腹部手术史，5例（62．5％）手术时间超过3h。术前5例（62．5％）有低蛋白血症，4例（50．0％）有贫血。所有病人均表现为上腹饱胀伴呕吐，胃振水音明显，鼻胃管引流出胃液800～1500mL／d。所有病人均经泛影葡胺胃造影确诊。均行保守治疗，7例（87．5％）保守治疗成功，其中5例（71．4％）于2周内治愈。结论：腹部非胃手术后功能性胃排空障碍是多病因疾病。多发生在胆道手术胆漏、复杂腹部手术、长期胃肠吻合输出襻梗阻解除后。消化道造影及胃镜检查是诊断的重要手段。采取保守治疗多可治愈，充分的术前准各和弃善的术后应b弹右勖干预防．

Objective To analyze the etiology, pathogenesis, diagnosis, treatment and prevention of functional delayed gastric emptying （FDGE） after nongastric abdominal surgery. Methods The clinical data of 8 patients with FDGE in our hospital from August 2011 to August 2012 were analyzed retrospectively. Results Eight patients with an average age of （69.9±11.2） underwent open abdominal surgery. Six cases （75.0%） had a history of abdominal surgery. The duration of operation was more than 3 hours in five cases （62.5%）. There was preoperative hypoalbuminemia in 5 cases （62.5%） and anemia in 4 cases （50.0%）. The symptoms in all cases were epigastric bloating, gastric splashing sound and large amount of fluid from nasogastric tube （800-1 500 mL/d）. The patients were all diagnosed by X ray examination using meglucamine diatrizoate. All of cases received non-operative treatment. Seven cases （87.5%） were cured and 5 cases （71.4%） relieved FDGE within 2 weeks. Conclusions There were multiple causes related to FDGE after nongastric abdominal surgery including bile leakage after biliary surgery, complex abdominal surgery and release of efferent loop obstruction of gastrointestinal anastomosis. Gastrointestinal imaging and gastroscopy are valuable methods in the diagnosis of FDGE. FDGE could be cured by non-operative treatment. The prevention consists of the careful preoperative preparation and comprehensive postoperative treatment.