28例上腹部手术后胃排空障碍临床体会(1)
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【摘要】 目的 探讨上腹部手术后胃排空障碍的临床原因和治疗方法。方法 对2002年12月至2008年12月本院768例上腹部手术后28例诊治为胃排空障碍的临床资料进行回顾性分析。结果 胃排空障碍均发生于上腹部手术后5~12 d。28例中胃相关手术患者占85.7%(24/28),其次术前流出道梗阻占75%(21/28)。中重度营养不良的发病率亦较高50%(14/28)。术后肠内营养患者发生率较低3.57%(1/28)。27例非手术综合治疗于术后10~58 d恢复胃动力,平均(19±1.4)d痊愈出院,1例放弃治疗自动出院。结论 预防胃排空障碍应有意识进行早期肠内营养,采取综合非手术疗法可治愈胃排空障碍,应尽量避免再次手术。
【关键词】胃排空障碍;临床原因;治疗方法
The clinical comprehension about the disorder of gastric emptying after operation on upper abdominal region
LIN Huan xiong,XIE Zhao xiong,CAI Wen,et al.Department of Gastroenterolgy Chaozhou Center Hospital,Chaozhou 521000,China
【Abstract】 Objective To approach the clinical reasons and the therapy methods about the disorder of gastric emptying after operation on upper abdominal region.Methods The author analyzed retrospectively the clinical data of 28 cases that were diagnosed as the disorder of gastric emptying.these 28 cases occur in 768 operations on upper abdominal region from 2002 Dec to 2008 Dec.Results The disorder of gastric emptying cases happened in 5 12 days after operations on upper abdominal.85.7%(24/28)patients undertook the operations about stomach,75%(21/28)patients had outflow obstruction before operations.50%had middle severe malnutrition.The incidence rate of the patients who had enteral nutrition are 3.57%(1/28).27 cases had the non operation combined therapy and recovered in 10 58 days after the operations.The average time was(19±1.4)days,and there was 1 case gave up the therapy.Conclusion To preven the disorder of gastric emptying should try to carry out the early enteral nutrition.The nonoperativ therapy can cure the disorder of gastric emptying,and one more operation should be avoided as far as possible.
【Key words】Disorder of gastric emptying; Clinical reason; Therapy method
胃排空障碍是指腹部术后继发的非机械性梗阻因素引起的胃排空延迟。临床常表现为术后数日开始进食,或由流质饮食改为半流质饮食后出现上腹胀满、膨隆及恶心呕吐等症状[1]。如何预防及正确地诊断和治疗胃排空障碍,减轻患者痛苦有着重要意义。我们对本院2002年12月至2008年12月诊治28例上腹部手术后胃排空障碍的临床资料进行回顾性分析。体会如下。
1 临床资料
1.1 一般资料 我院2002年12月至2008年12月间共收治上腹部手术后胃排空障碍患者28例,其中男18例,女10例。年龄29~72岁,平均46.5岁。入选诊断标准[2]:①经一项或多项检查提示无胃流出道机械性梗阻;②胃引流量>800 ml/d,持续时间超过10d;③无明显水、电解质平衡失调;④无引起胃瘫的基础疾病,如糖尿病、结缔组织疾病等;⑤未应用影响平滑肌收缩的药物。本组原发疾病为:胃窦癌13例,十二指肠溃疡并幽门梗阻4例,胰头癌2例,胃术后输出袢梗阻1例,贲门癌2例,重症急性胰腺炎1例,门静脉高压症1例,肝内外胆管结石1例,横结肠癌1例,粘连性肠梗阻1例,空肠系膜广泛挫裂伤1例 ......
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