腹腔镜胃癌根治术后胃排空障碍的原因与治疗

Postoperative gastric emptying dysfunction after laparoscopic radical gastrectomy:causes and management

腹腔镜胃癌根治术已成为胃癌手术治疗的常用方式,手术的安全性和有效性达到开腹手术标准,术后胃排空障碍(术后胃瘫综合征)严重影响患者康复,延长住院时间,增加医疗花费。术后胃瘫综合征发生原因和机制目前尚无明确定论,腔镜胃癌根治术后胃排空障碍的发生率并未因微创操作而较开放手术减少。应用各种影像学检查方法不仅可以有助于确诊,也可排除机械性梗阻因素。采用术前恢复胃的张力、术中置入肠内营养通路、术后维持血糖和白蛋白水平等预防措施的意义重于治疗。

Laparoscopic gastrectomy has become a common approach in gastric cancer surgery and could achieve equivalent clinical effects and safety as open gastrectomy. Postoperative delayed gastric emptying, also called postsurgical gastroparesis syndrome （PGS）, has a serious impact on recovery with prolonged hospitalization and increased medical cost. The pathogenesis of PGS is not clear till now. Compared to open gastrectomy, the incidence of PGS is not decreased by minimal invasion of laparoscopie radical gastreetomy. The application of various imaging examination methods could be helpful in the final diagnosis of PGS while excluding mechanical obstruction. Preventive managements could reduce the incidence of PGS, such as preoperative recovery of gastric tension, intra-operative insertion of nutrition feeding tube, postoperative maintenance of blood sugar level and albumin level.