Analysis of Multiple Factors for Gastric Paralysis Following Gastrectomy of Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GAOQi , WUYun-hua , CHENNan-zheng , ZHENGJian-bao , LIXiao-bin , WANGKai , WANGXun-kai ,  SUNXue-jun

Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China;

Corresponding author：

SUNXue-jun, Email: sunxy@mail.xjtu.edu.cn

Keywords：

Gastric cancer; Operation; Gastric paralysis; Logistic regression analysis

DOI：

10.7507/1007-9424.20160243

Video：

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Objective To explore risk factors of gastric paralysis following gastrectomy of gastric cancer and analyze its causes. Methods The clinical data of 116 patients with gastric cancer for hospitalization time more than 21 days following gastrectomy were retrospectively analyzed from October 2011 to October 2013 in this hospital, in which 16 patients with gastric paralysis and 116 patients without gastric paralysis. The factors relevant gastric paralysis were analyzed by logistic regression analysis. Results The results of single factor analysis showed that the preoperative body mass index, history of diabetes, operative time, postoperative cardiovascular complications, albumin and hemoglobin levels within 3 d after operation, time to get out of bed after surgery, extubation time of gastric tube, the first drinking time and the first feeding time were associated with the gastric paralysis (P < 0.05), but the gender, age, time of diabetes history, life mode, smoking history, hypertension history, pylorus preserving or not, laparoscopy or not, intraoperative blood loss, intraoperative blood transfusion, uses of postoperative intraperitoneal chemotherapy drugs and postoperative analgesic drugs, and indwelling time of jejunum nutrition tube were not associated with gastric paralysis (P > 0.05). The results of logistic regression analysis showed that the preoperative body mass index, history of diabetes, operative time, time to get out of bed after surgery, and postoperative cardiovascular complications were the independent risk factors of gastric paralysis (P < 0.05). Conclusions There are many factors that affect occurrence of gastric paralysis following gastrectomy of gastric cancer. Preoperative or intraoperative positive prevention measures could be taken according to the factors that might affect occurrence of gastric paralysis, which might be reduce gastric paralysis following gastrectomy of gastric cancer.

Citation： GAOQi, WUYun-hua, CHENNan-zheng, ZHENGJian-bao, LIXiao-bin, WANGKai, WANGXun-kai, SUNXue-jun. Analysis of Multiple Factors for Gastric Paralysis Following Gastrectomy of Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(8): 926-930. doi: 10.7507/1007-9424.20160243 Copy

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2.	Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline:management of gastroparesis. Am J Gastroenterol, 2013, 108(1):18-38.
3.	Waseem S, Moshiree B, Draganov PV. Gastroparesis:current diagnostic challenges and management considerations. World J Gastroenterol, 2009, 15(1):25-37.
4.	王向阳, 张克难, 冯安明, 等.根治性远端胃大部切除术后胃瘫危险因素的分析.中国普通外科杂志, 2010, 19(10):1156-1158.
5.	王永超, 李强.胃切除术后胃排空障碍危险因素的Meta分析.中华胃肠外科杂志, 2014, 17(7):687-693.
6.	Yang J, Wang C, Huang Q. Effect of Billroth Ⅱ or Roux-en-Y reconstruction for the gastrojejunostomy after pancreaticoduodenectomy:Meta-analysis of randomized controlled trials. J Gastrointest Surg, 2015, 19(5):955-963.
7.	吕振晔, 钱振渊, 叶再元, 等.远端胃癌术后胃瘫多因素分析.中国中西医结合外科杂志, 2013, 19(1):9-11.
8.	Murakami Y, Uemura K, Sudo T, et al. An antecolic Roux-en Y type reconstruction decreased delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Gastrointest Surg, 2008, 12(6):1081-1086.
9.	Nikfarjam M, Kimchi ET, Gusani NJ, et al. A reduction in delayed gastric emptying by classic pancreaticoduodenectomy with an antecolic gastrojejunal anastomosis and a retrogastric omental patch. J Gastrointest Surg, 2009, 13(9):1674-1682.
10.	Tani M, Terasawa H, Kawai M, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy:results of a prospective, randomized, controlled trial. Ann Surg, 2006, 243(3):316-320.
11.	Eshuis WJ, van Dalen JW, Busch OR, et al. Route of gastroenteric reconstruction in pancreatoduodenectomy and delayed gastric emptying. HPB (Oxford), 2012, 14(1):54-59.
12.	Oida T, Mimatsu K, Kano H, et al. Antecolic and retrocolic route on delayed gastric emptying after MSSPPD. Hepatogastroenterology, 2012, 59(116):1274-1276.
13.	Hartel M, Wente MN, Hinz U, et al. Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg, 2005, 140(11):1094-1099.
14.	Hayakawa T, Kaneko H, Konagaya T, et al. Enhanced somatostatin secretion into the gastric juice with recovery of basal acid output after Helicobacter pylori eradication in gastric ulcers. J Gastroenterol Hepatol, 2003, 18(5):505-511.
15.	Boaz M, Kislov J, Dickman R, et al. Obesity and symptoms suggestive of gastroparesis in patients with type 2 diabetes and neuropathy. J Diabetes Complications, 2011, 25(5):325-328.
16.	Watkins CC, Sawa A, Jaffrey S, et al. Insulin restores neuronal nitric oxide synthase expression and function that is lost in diabetic gastropathy. J Clin Invest, 2000, 106(3):373-384.
17.	Parmar AD, Sheffield KM, Vargas GM, et al. Factors associated with delayed gastric emptying after pancreaticoduodenectomy. HPB (Oxford), 2013, 15(10):763-772.
18.	Camilleri M, Grover M, Farrugia G. What are the important subsets of gastroparesis? Neurogastroenterol Motil, 2012, 24(7):597-603.
19.	Søfteland E, Brock C, Frøkjær JB, et al. Rectal sensitivity in diabetes patients with symptoms of gastroparesis. J Diabetes Res, 2014, 2014:784841.
20.	Bharucha AE, Batey-Schaefer B, Cleary PA, et al. Delayed gastric emptying is associated with early and long-term hyperglycemia in type 1 diabetes mellitus. Gastroenterology, 2015, 149(2):330-339.
21.	Bernard CE, Gibbons SJ, Mann IS, et al. Association of low numbers of CD206-positive cells with loss of ICC in the gastric body of patients with diabetic gastroparesis. Neurogastroenterol Motil, 2014, 26(9):1275-1284.
22.	Vanormelingen C, Tack J, Andrews CN. Diabetic gastroparesis. Br Med Bull, 2013, 105:213-230.
23.	Stanghellini V, Tack J. Gastroparesis:separate entity or just a part of dyspepsia? Gut, 2014, 63(12):1972-1978.
24.	Grover M, Bernard CE, Pasricha PJ, et al. Clinical-histological associations in gastroparesis:results from the Gastroparesis Clinical Research Consortium. Neurogastroenterol Motil, 2012, 24(6):531-539, e249.
25.	何森.不同消化道重建术式在胃癌患者全胃切除术中的应用比较.中国医药导刊, 2012, 13(7):1134.

1. Quigley EM. Other forms of gastroparesis:postsurgical, Parkinson, other neurologic diseases, connective tissue disorders. Gastroenterol Clin North Am, 2015, 44(1):69-81.
2. Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline:management of gastroparesis. Am J Gastroenterol, 2013, 108(1):18-38.
3. Waseem S, Moshiree B, Draganov PV. Gastroparesis:current diagnostic challenges and management considerations. World J Gastroenterol, 2009, 15(1):25-37.
4. 王向阳, 张克难, 冯安明, 等.根治性远端胃大部切除术后胃瘫危险因素的分析.中国普通外科杂志, 2010, 19(10):1156-1158.
5. 王永超, 李强.胃切除术后胃排空障碍危险因素的Meta分析.中华胃肠外科杂志, 2014, 17(7):687-693.
6. Yang J, Wang C, Huang Q. Effect of Billroth Ⅱ or Roux-en-Y reconstruction for the gastrojejunostomy after pancreaticoduodenectomy:Meta-analysis of randomized controlled trials. J Gastrointest Surg, 2015, 19(5):955-963.
7. 吕振晔, 钱振渊, 叶再元, 等.远端胃癌术后胃瘫多因素分析.中国中西医结合外科杂志, 2013, 19(1):9-11.
8. Murakami Y, Uemura K, Sudo T, et al. An antecolic Roux-en Y type reconstruction decreased delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Gastrointest Surg, 2008, 12(6):1081-1086.
9. Nikfarjam M, Kimchi ET, Gusani NJ, et al. A reduction in delayed gastric emptying by classic pancreaticoduodenectomy with an antecolic gastrojejunal anastomosis and a retrogastric omental patch. J Gastrointest Surg, 2009, 13(9):1674-1682.
10. Tani M, Terasawa H, Kawai M, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy:results of a prospective, randomized, controlled trial. Ann Surg, 2006, 243(3):316-320.
11. Eshuis WJ, van Dalen JW, Busch OR, et al. Route of gastroenteric reconstruction in pancreatoduodenectomy and delayed gastric emptying. HPB (Oxford), 2012, 14(1):54-59.
12. Oida T, Mimatsu K, Kano H, et al. Antecolic and retrocolic route on delayed gastric emptying after MSSPPD. Hepatogastroenterology, 2012, 59(116):1274-1276.
13. Hartel M, Wente MN, Hinz U, et al. Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg, 2005, 140(11):1094-1099.
14. Hayakawa T, Kaneko H, Konagaya T, et al. Enhanced somatostatin secretion into the gastric juice with recovery of basal acid output after Helicobacter pylori eradication in gastric ulcers. J Gastroenterol Hepatol, 2003, 18(5):505-511.
15. Boaz M, Kislov J, Dickman R, et al. Obesity and symptoms suggestive of gastroparesis in patients with type 2 diabetes and neuropathy. J Diabetes Complications, 2011, 25(5):325-328.
16. Watkins CC, Sawa A, Jaffrey S, et al. Insulin restores neuronal nitric oxide synthase expression and function that is lost in diabetic gastropathy. J Clin Invest, 2000, 106(3):373-384.
17. Parmar AD, Sheffield KM, Vargas GM, et al. Factors associated with delayed gastric emptying after pancreaticoduodenectomy. HPB (Oxford), 2013, 15(10):763-772.
18. Camilleri M, Grover M, Farrugia G. What are the important subsets of gastroparesis? Neurogastroenterol Motil, 2012, 24(7):597-603.
19. Søfteland E, Brock C, Frøkjær JB, et al. Rectal sensitivity in diabetes patients with symptoms of gastroparesis. J Diabetes Res, 2014, 2014:784841.
20. Bharucha AE, Batey-Schaefer B, Cleary PA, et al. Delayed gastric emptying is associated with early and long-term hyperglycemia in type 1 diabetes mellitus. Gastroenterology, 2015, 149(2):330-339.
21. Bernard CE, Gibbons SJ, Mann IS, et al. Association of low numbers of CD206-positive cells with loss of ICC in the gastric body of patients with diabetic gastroparesis. Neurogastroenterol Motil, 2014, 26(9):1275-1284.
22. Vanormelingen C, Tack J, Andrews CN. Diabetic gastroparesis. Br Med Bull, 2013, 105:213-230.
23. Stanghellini V, Tack J. Gastroparesis:separate entity or just a part of dyspepsia? Gut, 2014, 63(12):1972-1978.
24. Grover M, Bernard CE, Pasricha PJ, et al. Clinical-histological associations in gastroparesis:results from the Gastroparesis Clinical Research Consortium. Neurogastroenterol Motil, 2012, 24(6):531-539, e249.
25. 何森.不同消化道重建术式在胃癌患者全胃切除术中的应用比较.中国医药导刊, 2012, 13(7):1134.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Multiple Factors for Gastric Paralysis Following Gastrectomy of Gastric Cancer

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