远端胃切除残胃与空肠双襻吻合术后胃排空障碍的观察与干预对策

Observation and intervention of delayed gastric emptying after distal gastrectomy with gastric stump and jejunum double loop anastomosis for gastric cancer

目的探讨五观察五干预对策管理模式对防治远端胃癌切除残胃与空肠双襻吻合术后胃排空障碍的临床意义。方法对129例腹腔镜与开腹胃切除术残胃与空肠双襻加侧侧吻合重建术患者,在围手术期中采用五观察五干预对策管理模式的临床效果进行回顾分析。结果本组行远端胃大部切除术129例,其中腹腔镜手术93例,开腹手术36例,手术均获得成功。术后发生胃功能性排空障碍11例(8.5%),经持续胃肠减压,肠外营养支持保守治疗7~21 d胃排空障碍解除5例(45.5%),其余6例经胃镜下放置营养管至空肠侧吻合口远端空肠内25~30 cm,每日经空肠输食管进行肠内营养支持、中药、心理疏导等综合治疗后,第28天胃排空障碍解除2例(18.2%),第39天胃排空障碍解除1例(9.0%),第43天胃排空障碍解除2例(18.2%),最长第56天胃排空障碍解除1例(9.0%)。并发肺部感染4例(36.4%)经抗感染对症治疗痊愈;伴有焦虑、抑郁等心理问题6例(54.5%),经心理疏导和药物对症治疗获得到控制。11例患者均经综合保守治疗胃排空障碍解除,无再手术病例,康复出院。结论采用五观察五干预对策管理模式对腹腔镜与开腹远端胃癌切除残胃与空肠双襻吻合术后并发胃排空障碍防治可获得良好的临床效果,值得临床推广。

Objective to investigate the clinical significance of management mode with five observation method and five intervention countermeasures of delayed gastric emptying after distal gastric cancer resection with gastric stump and jejunum double loop anastomosis.Methods The clinical effect of management mode with five observation method and five intervention countermeasures was analyzed retrospectively in the perioperative period among 129 cases of distal gastric cancer resection with residual stomach and jejunum double loop and side-side anastomosis by laparoscopic or laparotomy surgery.Results In 129 cases of distal gastric cancer resection,93 cases were performed by laparoscopic surgery and 36 cases were performed by laparotomy surgery,all of which were successful.11 cases(8.5%)were diagnosed with functional delayed gastric empting after surgery,5 cases of which were relieved after treated with continuous gastrointestinal decompression and parenteral nutrition support therapy during7 to 21d,and 6 cases of which were placed the gastrointestinal nutrition tube into the distal jejunum over jejunum anastomosis measurement within 25 to 30 cm by using gastroscope,and through given comprehensive treatment with enteral nutrition support by the gastrointestinal nutrition tube,traditional Chinese medicine and psychological counseling everyday,the dysfunction of gastric emptying was relieved in 2 cases(18.2%)at 28 days and 1 case(9.0%)at 39 days and 2 cases(18.2%)at 43 days,and 1 case(9.0%)at 56 days.During this period,4 cases(36.4%)with pulmonary infection were cured by anti-infection treatment,6 cases(54.5%)with anxiety and depression were got control and anesis by psychological counseling and drug treatment.the dysfunction of gastric emptying was relieved in 11 cases,no case with reoperation of which was found and all of which were discharged from hospital upon recovery.Conclusion The good clinical effect was obtained by using the management mode with five observation method and five intervention countermeasures for delayed gastric emptying of distal gastric cancer resection with residual stomach and jejunum double loop anastomosis by aparoscopic or laparotomy surgery.It should be popularized and applied in clinical.