术后胃瘫的治疗进展

Treatment of postoperative gastroparesis

术后胃瘫延长住院时间、增加医疗费用并造成很多不良后果。对胃正常生理运动功能的研究有助于指导术后胃瘫的治疗。很多机制参与术后胃瘫的发生发展,如神经-化学因素、炎症反应、阿片类麻醉药物、部分胃切除、补液过多、低血压和缩血管药物等等。术后胃瘫治疗应采取综合性的治疗,包括术前、术中和术后的一系列预防性措施。针对性治疗主要是药物治疗,目前新的治疗方法如内镜下内毒素及支架治疗、胃电起搏治疗的效果尚需进一步研究。腔镜下幽门成形术可用来治疗内科保守治疗无效的胃瘫。而以经口内镜下胃幽门肌切开术(gastric peroral endoscopic pyloromyotomy, G-POEM)为代表的微创治疗在难治性胃瘫中的作用日益受到推崇。

Postoperative gastroparesis increases hospitalization time, medical expenses and caused many adverse consequences. The study of the normal physiological motor function of the stomach helps to guide the treatment of postoperative gastroparesis. Many mechanisms are involved in the development of postoperative gastroparesis, such as neuro-chemical factors, inflammatory reactions, opioid anesthetics, partial gastrectomy, excessive fluid replacement, hypotension, and vasoconstrictor drugs. Postoperative gastroparesis should be treated in a comprehensive manner, including a series of preventive measures before, during and after surgery. Targeted treatment is mainly drug treatment. At present, the effects of new treatment methods such as endoscopic endotoxin, stent placement and gastric pacing therapy need further investigation. Endoscopic py- loric angioplasty can be used to treat stomach cramps that are ineffective in conservative medical treatment. The role of minimally invasive treatment represented by gastric peroral endoscopic pyloromyotomy （G-PO- EM ） in refractory gastric fistula is increasingly recognized as an efficient treatment.