目的 总结手术后胃瘫的临床诊治经验。方法 对我院1986～2001年期间上腹部手术后并发胃瘫的31例患者的临床资料进行回顾性分析。结果 手术后胃瘫的临床表现主要为腹胀、呕吐，无明显腹痛，大多数患者肛门排气正常。消化道X线钡餐造影可见胃蠕动差，胃镜检查见吻合口通畅。31例经胃肠减压，营养支持，维持水、电解质代谢平衡，以及用促进胃肠蠕动的药物等非手术治疗均得以缓解。结论 手术后胃瘫的诊断主要依据临床表现; 胃镜检查有其重要价值; 排除机械性梗阻后，应积极采取非手术治疗，不应盲目再次手术。
【摘要】 目的 探讨腹部非胃、十二指肠手术后胃瘫综合征（postoperative gastroparesis syndrome，PGS）发生的高危因素。 方法 回顾分析2004年9月-2010年3月2 559例腹部非胃、十二指肠术后患者的临床资料，将患者分为PGS组和非PGS组，其中PGS组23例，非PGS组2 536例。 结果 比较PGS组和非PGS组间年龄、性别、术后开始进食时间、手术持续时间、是否为肿瘤晚期、有无贫血低蛋白血症、既往有无腹部手术史、术后早期有无营养支持等因素，χ2值分别为:19.687、0.018、0.346、48.243、21.801、16.803、24.679、0.870，P值分别是:lt;0.01、gt;0.05、gt;0.05、lt;0.01、lt;0.01、lt;0.01、lt;0.01、gt;0.05。 结论 年龄gt;65岁、手术持续时间gt;4 h、肿瘤晚期、既往有腹部手术史及贫血低蛋白血症是腹部非胃、十二指肠手术后PGS发生的高危因素。【Abstract】 Objective To analyze the risk factors of postoperative gastroparesis syndrome (PGS) after non-gastroduodenal abdominal surgery. Methods We retrospectively analyzed the clinical data of 2 559 patients who underwent non-gastroduodenal abdominal surgeries in our hospital between September 2004 and March 2010. We divided them into the PGS group with 23 patients and the non-PGS group with 2 536 patients. Results By comparing the age, the gender, the starting time of eating after surgery, the duration of surgery, whether the patients had advanced cancer, whether anemia or hypoproteinemia existed, whether the patients had a history of previous abdominal surgery, and whether nutritional support was provided early after operation between the PGS group and the non-PGS group, we found that the chi-square value was 19.687, 0.018, 0.346, 48.243, 21.801, 16.803, 24.679, 0.870 and the P value waslt;0.01, gt;0.05, gt;0.05, lt;0.01, lt;0.01, lt;0.01, lt;0.01, gt;0.05 respectively. Conclusion Over 65 years of age, the duration of surgery over four hours, advanced cancer, the history of previous abdominal surgery and anemia or hypoproteinemia are the risk factors of PGS after non-gastroduodenal abdominal surgery.
目的 总结腹部手术后胃瘫综合征（PGS）的病因、诊断及治疗方法。方法回顾性分析我院2003年1月至2009年3月期间行腹部手术后发生胃瘫的30例患者的临床资料。结果 PGS发生于术后5～10 d，通过临床表现、上消化道造影及胃镜检查明确诊断。全组均经营养支持、药物治疗等保守治疗后治愈，治愈时间14～62 d，平均25 d。结论 PGS是由多种因素导致的,上消化道造影及胃镜检查是诊断PGS的可靠方法,保守治疗为其主要治疗手段，应尽量避免再次手术。
ObjectiveTo analyze risk factors of gastric paralysis following pancreaticoduodenectomy so as to offer help for prevention and treatment of gastric paralysis. MethodDomestic and international literatures about gastric paralysis following pancreaticoduodenectomy were collected, diagnostic criteria, risk factors, and the latest progress of gastric paralysis were summarized. ResultsGastric paralysis is one of the most common postoperative complications following pancreaticoduodenectomy. It might be caused by many risk factors, such as operation method, gastrointestinal anastomosis, abdominal complications, chronic hyperglycemia, and excess infusion, etc. ConclusionsAlthough definition of gastric paralysis by ISGPS is widely adopted, it fails to distinguish gastric paralysis from impaired gastric function related to other postoperative complications and it might result in an overestimation of its true morbidity. The risk factors of occurrence of gastric paralysis are still in controversy and results of research in different centers are not same, more prospective randomized controlled trials are needed.
ObjectiveTo explore risk factors of gastric paralysis following gastrectomy of gastric cancer and analyze its causes. MethodsThe 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. ResultsThe 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). ConclusionsThere 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.
Objective To summarize clinical diagnosis and treatment of 1 case of hypothyroidism complicated with postoperative gastroparesis syndrome (PGS) after radical resection of right colon cancer. Method The multi-disciplinary (MDT) mechanism was used to discuss the MDT consultations of the departments of general surgery, endocrinology, nutrition, radiology, and pathology in a patient with hypothyroidism and right colon cancer after the radical resection. Results The MDT discussion concluded that the patient had a clear diagnosis of right colon cancer before the surgery, and the PGS occurred after the radical resection of right colon cancer. The patient had the hypothyroidism before the operation, and the occurrence of PGS might be related to the hypothyroidism. The experts of MDT recommended to treat with the thyroxine sodium and nutritional support treatment after the surgery. According to the results of the MDT discussion, the patient’s PGS was gradually cured and discharged smoothly after the thyroxine supplementation and nutritional support. Conclusions Hypothyroidism may be a risk factor for occurrence of PGS after radical resection of right colon cancer. MDT mechanism can provide an individualized optimal treatment for patients with hypothyroidism complicated with PGS after radical resection of right colon cancer and benefit these patients.