腹腔镜辅助直肠癌术后并发胃瘫10例临床分析

The clinical analysis of 10 cases of postoperative gastroparesis after laparoscopic-assisted rectal cancer

目的：探讨腹腔镜辅助直肠癌术后并发胃瘫的可能病因及综合治疗措施。方法回顾性分析我院近年来腹腔镜辅助直肠癌术后发生胃瘫的10例患者的临床资料及综合治疗效果。结果10例患者，男性3例，女性7例。在手术后4-5 d 肛门排气后进食流质饮食出现上腹饱胀、恶心呕吐，呕吐物含有胆汁样胃液。给予留置胃肠减压管，每天可吸出800 ml 以上胆汁样胃液。经胃管行胃造影显示胃无蠕动4例或蠕动明显减弱6例，观察5-6 h 造影剂仍滞留胃内。予以持续胃肠减压、静脉营养支持等治疗；并采用促进胃肠动力药物和中医针灸治疗等非手术治疗；全部患者于胃瘫发生后7-15（平均12.3）d 恢复胃动力。结论腹腔镜辅助下直肠癌术后并发胃瘫，是多种因素所致短暂性胃功能改变，可能与麻醉、患者精神因素等有关，经非手术的综合治疗措施可治愈。

Objective To investigate the possible causes and comprehensive treatment measures of postoperative complication of gastroparesis after paroscopic -assisted rectal cancer. Methods A retrospective analysis on clinical data and comprehensive treatments of 10 patients of our hospital in recent years, which suffer from gastroparesis after the laparoscopic-assisted rectal cancer surgery. Results When eating liquid diet after surgery and 4-5 days anus exhaust, 10 patients （3 men and 7 females） appeared the phenomenon of epigastric fullness, nausea and vomiting with containing bile juice. Indwelling gastrointestinal decompression tube, it could be sucked out of more than 800ml bilious gastric juice every day. Gastric angiography（76% diatrizoate） showed four cases in which the stomach is without peristalsis, and six cases in which the stomach is significantly weakened, and after 5 -6 h observation, contrast agents stranded in the stomach. With continuous decompression, and parenteral nutrient support therapy, as well as non-surgical treatments including gastrointestinal motility drugs and acupuncture treatment, all patients with gastroparesis restore gastric motility after 7 -15 （average 12.3） days. Conclusions The occurrence of gastroparesis after laparoscopic-assisted rectal, was a transient change in gastric function, due to a variety of causes. It may be associated with the anesthesia and patients’ mental factors, and could be cured by non-surgical treatment.