陈正煊 陈创奇 赖佳明 中山医科大学附属第一医院胃肠胰外科(广州.510080) 中国胃肠外科杂志 1999 0 2 1


    关键词：胃手术；手术后并发症；胃排空障碍 期刊 zgwcwkzz 0 论著 fur -->


    

摘要 目的 探讨胃手术后排空障碍的特点和处理。方法 回顾分析39例胃术后功能性和机械性排空障碍的临床特点、手术和非手术治疗的选择以及非手术治疗的措施。结果 经保守治疗后6例好转；手术探查33例。术中证实为机械性因素引起梗阻26例；7例未发现明显机械性梗阻因素，其中4例作Braun's吻合，3例仅作探查空肠造瘘术，除1例术后仍出现排空障碍自动出院外，其余病人均治愈或好转出院。结论 胃术后排空障碍可能是功能性引起，也可能是机械性梗阻造成。应根据其临床表现、X线钡餐及胃镜检查的特征加以鉴别。如没有绞窄征象，应先行保守治疗，在胃肠减压，维持水电解质酸碱平衡的基础上可加用胃肠动力药，如排空障碍是功能性原因引起，大多症状在2～3周内缓解，若无缓解征象，应考虑手术探查。

The differentiation and treatment of functional and mechanical postgast rectomy emptying disorders

Chen Zhengxuan, Chen Chuangqi, Lai Jiaming.

    Department of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat -sen University of Medical Sciences, Guangzhou 510080

Abstract Objective To evaluate the clinical characters and t reatment of postgastrectomy emptying disorders. Method The cl inical data of 39 cases of postgastrectomy emptying disorders were analyzed retr ospectively, including the clinical characters, the alternatives of surgical and conservative treatment,and the means of conservative treatment. Results The situation of 6 patients improved after conservative treatment. The other 33 patients underwent laparotomy. 26 cases, caused by mechanical factor s, were confirmed during laparotomy. Another 7 cases in which no obvious m echanical factors were found, 4 cases underwent Braun's anastomosis, 3 cases und erwent jejunostomy. All the patients' status improved or totally recovered except 1case failed to correct emptying disorders. Conclusions Po stgastrectomy emptying disorders are caused by either functional or mechanical f actor. The clinical manifestations,x-ray barium meal examination and gastroscop ic examination are important for distinguishing these two factors. Conservative treatment is suggested except for case of intestinal strangulation. The means of conservative treatment include maintenance of fluid and electrolyte balance and acid-base balance, continuous gastric tube sucking and administration of gastr ointestinal motility drugs. Those caused by functional emptying disorders may alleviate in 2～3 weeks.If not, laparotomy should be considered to carry out.

     Key words Gastrectomy Postoperative complication Gastric em ptying disorder

胃术后功能性排空障碍与机械性梗阻是术后常见的并发症 ......