非胃手术后胃瘫6例临床分析

Gastroparesis after non-gastric operations:clinical analysis of 6 cases

目的 探讨非胃手术后胃瘫的病因 ,寻找正确有效的诊断和治疗方法。方法 分析 1992～ 2 0 0 1年 6例非胃手术后胃瘫病人的临床表现、诱发因素、治疗方法和效果。结果 非胃手术后胃瘫多发生于病情复杂、手术创伤大、手术时间长的病人。主要表现为上腹胀、呕吐 ,胃引流量增多。胃造影和胃镜检查不仅是检查手段 ,而且对胃蠕动的恢复有促进作用。非连续性全胃肠道外营养 (TPN)可以促进胃动力的恢复。结论 腹部非胃手术后可发生胃瘫。胃造影、胃镜的机械刺激作用和短暂中断TPN作为辅助刺激对胃瘫的恢复有促进作用。对于创伤大、时间长的腹部非胃手术 ,预防性营养性空肠造口是明智的选择。

Objective To investigate the etiology,diagnosis and treatment of gastroparesis after non-gastric abdominal operation. Methods Clinical manifestations,inducing factors,treatment and results were analyzed in 6 cases with gastroparesis after non-gastric abdominal operations.Results Gastroparesis was more frequent in patients with complicated major non-gastric abdominal operations,characterized by upper abdominal distention,vomiting and large quantity of gastric drainage.Gastroscopy and gastrograph were not only valuable in the diagnosis of gastroparesis but also effective for promoting gastric motility.It seemed to be helpful to cease TPN for 1～2 days during a continual TPN course for the paralyzed stomach to recover.Conclusion Adjuvant stimulation with gastroscopy,gastrograph and ceasing TPN for 1～2 days during TPN courses are helpful in the treatment of gastroparesis.Preventive Stamm’s enterostomy is advisable for those cases with severe trauma and long duration.