胃切除术后功能性排空障碍诊治的的体会.docVIP

胃切除术后功能性排空障碍诊治的的体会 　　摘要目的：探讨胃大部切除术后功能性排空障碍的诊断和治疗。方法：对于1998-2007年发生于胃大部切除术后的功能性排空障碍22例临床资料进行回顾性分析。结果：本组共发生功能性排空障碍22例，发生率为4.5%，发生于术后第6--12天共19例, 第5天、14天、15天各1例。20例病人经保守治疗20天内痊愈出院，2例因误诊(其中1例再手术，术中未见吻合口梗阻；另1例误诊为胃术后部分肠粘连，吻合口梗阻) 延长住院时间亦经保守治疗痊愈出院，胃功能恢复时间平均17.1天。结论：胃术后功能性排空障碍多种因素引起术后残胃和远端空肠正常的运动功能破坏是发生功能性排空障碍的主要原因，除临床上特点外，消化道造影及胃镜检查是诊断本病及与机械性梗阻鉴别重要方法。正确治疗方法应采用严格的保守治疗，针对胃排空动力学机制的改变采用促胃肠动力药物可收到较好的疗效。 　　关键词胃大部切除术；胃排空 　　 　　AbstractObjective：To investigate the diagnosis and treatment of functional delayed gastric emptying(FDGE). Methods：The clinical data of 22 patients who suffered from PDGE after having subtotal gastrectomy from 1998 to 2007 were restrospectively analysed. Result：There are 22 cases in this group ,ratio of occurring is 4.5%. PDGE occurred in 19 patients with 6 to 12 days and 1 patients with 5 、14 、15 days after surgery. 20 patients recovered with medical therapy and were discharged by 20 days. An erroneous diagnosis occurred in 2 patients (operated on 1 patient and join together was not narrow.anther 1 was mistaken as part intestines conglutination and block of anastomose gob after gastrectomy.)and also recovered with medical therapy by the extension stay in the hospitals time. Recovering time of gastric function average 17.1 days. Conclusion：Alteration of gastrointestinal motility may be the main cause of FDGE. Besides clinical top characteristics.An upper gastrointestinal radiography and endoscopy are the important methods of diagnosis of FDGE and differential diagnosis with mechanical ileus. Gastrointestinal motility can return spontaneously after a period of medical therapy and there is no need for reoperation for gastric stasis. Some gastrointestinal dynamic promoting drugs may have had a beneficial effect on the postoperative gastrointes motility. 　　Key wordsSubtotal gastrectomy ；Gastric emptying 　　 　　胃切除术后功能性排空障碍（functional delayed gastric emptying，FDGE）指不伴有吻合口或输出袢等机械性梗阻因素的残胃无力、排空迟缓，经保守治疗后可恢复的一种胃术后并发症，又称残胃无力症、胃排空延迟综合征或胃瘫综合征。在1998-2007年进行的467例胃大部切除