胃癌根治术后残胃功能性排空障碍的治疗(附15例报告)

Combinative Therapy of Functional Delayed Gastric Emptying after Radical Gastrectomy

目的 :探讨胃癌根治术后残胃功能性排空障碍 (Functionaldelayedgastricemptying ,FDGE)的发生原因和中西医结合治疗的疗效。方法 :对 1996年 1月～ 2 0 0 1年 12月 312例胃癌根治术的临床资料进行回顾性分析。结果 :本组发生FDGE 15例 ,发生率 4 .81%。其中 2 88例行D2 根治术 ,发生FDGE 12例 (4.17% ) ;2 4例行D2 合并胆囊切除术 ,发生FDGE 3例(12 .5 % )。FDGE表现为术后大量胃液引流、不能耐受夹管 2例 (13.3% ) ;进食流质时出现胃潴留 4例 (2 6 .7% ) ;进食半流质时出现胃潴留 9例 (6 0 % )。经保守治疗 ,本组病例均痊愈出院。病程 11～ 32d ,平均 2 1.33± 4 .75d。无再次手术病例。结论 :胃癌根治术BillrothⅡ式胃肠重建时输出襻吻合口位置过高是发生FDGE的一个技术因素。残胃与输出襻间运动的不同步协调与FDGE的关系更为密切。肠内营养可以维持患者营养状态 ,提高对FDGE长期病程的耐受能力。FDGE自愈可能很大 ,应慎重手术。

Objective:To explore the pathogenesis of functional delayed gastric emptying (FDGE) after radical gastrectomy and evaluate the effect of Traditional Chinese medicine (TCM) combined with Western medicine on FDGE. Methods: A retrospective study was performed including 312 cases undergone radical gastrectomy during 6 years period time. Results: 15 FDGE cases were found and the overall incidence rate is 4.81%. Among these cases, 288 patients underwent radical operation (D 2 ), in which 12 FDGE cases (4.17%) were found; 3 FDGE cases (12.5%) were done in 24 patients undergone radical surgery and cholecystectomy. The syndromes of FDGE mainly included generous gastric juice, gastric-tube-shut intolerance (2 cases, 13.3%), gastric retention after liquid-diet (4 cases, 26.7%), and gastric retention after congee-diet (9 cases, 60%). The overall 15 FDGE cases were cured through medical therapy and the course ranged 11～32 (21.33±4.75d). None re-operation was performed. Conclusion: One of the skill reasons causing FDGE might be the over-height of gastrojejunostomic anastomosis. Incoordination between remnant and output loop might be closely related to PDGE. Enteral nutrition by nosal-jejunal tube might improve patient's status and enhance patient's tolerance on prolonged course. Patients have great spontaneous cure chance and re-operation should be cautious.