胃大部切除术后并发胃瘫的诊治体会

Diagnosis and Therapy of Gastroparesis after Subtotal Gastrectomy

目的 总结胃大部切除术后急性胃瘫的临床诊治经验。 方法 对 1985年至 1999年行胃大部切除术后发生胃瘫的 19例病人的治疗过程和效果进行回顾性分析。 结果 胃瘫临床表现为胃潴留 ,而无明显腹痛 ,大多数肛门排气正常。消化道造影可见胃蠕动差 ,胃镜检查吻合口通畅。 18例经胃肠减压 ,支持营养 ,维持水电解质代谢平衡 ,以及用促进胃肠动力药物均得以缓解。 1例再次手术后恢复时间更长。 结论 胃大部切除术后胃瘫的诊断主要依据临床表现 ,胃镜检查有重要价值 ,排除存在机械性梗阻后应积极采取非手术治疗 ,尤其是胃肠动力促进剂的应用 。

Objective To review the diagnosis and treatment of gastroparesis after subtotal gastrectomy. Methods The clinical data of 19 patients with gastroparesis after subtotal gastrectomy between 1985 and 1999 were retrospectively analyzed. Results The symptoms of gastroparesis were the serial phenomenons of gastric fullness. The patients had no obvious pain in the abdomen. Most of them expelled flatus normally. The upper gastrointestinal radiography showed a decrease in gastric motility, and endoscopy showed no stomal obstruction. Eighteen cases had curative effects through the reduction of gastric pressure, maintenance of hydroelectrolytic balance and nutritional status, and application of prokinetic drugs. One case underwent a second operation and recovery was delayed. Conclusion The diagnosis of gastroparesis mainly depends on the clinical appearances and gastroendoscopy. When the gastroparesis is confirmed, the patient should be actively treated by conservative means, especially by the application of prokinetic agents. Unnecessary reoperation should be avoided.