食管癌切除术后胃排空障碍的原因及防治

Causes,treatment and prevention of delayed gastric emptying (DGE) after operation for esophageal carcinoma

目的 探讨食管癌切除术后胃排空障碍的原因及防治措施。方法 对食管癌术后并发胃排空障碍 17例患者的临床资料进行回顾性分析。结果 本组均发生于术后 7～ 12天 ,其中 12例功能性胃排空障碍经保守治疗 ,治愈 11例 ,死亡 1例 ,5例机械性胃排空障碍均经手术治愈 ,本组死亡率为 5 .88%。结论 迷走神经切断及胃解剖位置的变化是胃排空障碍的主要原因 ,其次胃排空障碍也与胃扭转、术后粘连等因素有关。X线钡剂造影及胃镜检查是诊断本病的主要方法。功能性胃排空障碍 ,一般行保守治疗 ;机械性胃排空障碍 ,应尽早手术。术前充分准备 ,手术操作认真、规范 ,术后恰当处理 。

Objective To investigate the causes, measures of treating and preventing of DGE after operation for esophageal carcinoma.Methods The clinical data of 17 cases for DGE after operation for esophageal carcinoma were analysed retrospectively. Results DGE occurred in 7 to 12 day after operation. 11 cases with functional delayed gastric emptying(FDGE) recovered with conservative treatment and 1 case death. 5 cases with mechanical delayed gastric emptying (MDGE) were surgical treatment. Conclusion The section of vagus nerve with anatomical displacement of stomach may be the main causes of DGE. MDGE related to gastric volvulus and postoperative adhesion etc. X\|ray barium meal radiography and gastroscopy examination are the important diagnostic methods. Conservative treatment should be the first choice for FDGE. The use of some gastro-intestinal prokinetic drugs may have a beneficial effect on FDGE. Once the diagnosis of MDGE is established, surgical treatment should be performed as early as possible. The fully preoperative preparation, the precise and concise techniques in operation and postoperative appropriate management may decrease the occurrence of DGE.