【作者】 陈曦；

【导师】 李良庆；

【作者基本信息】 福建医科大学 ， 外科学， 2015， 硕士

【摘要】 目的:PGS特指手术后并发的以胃运动功能不佳为主的一种临床综合征,常发生在腹部手术后,其中单纯胃术后患者中有10%~25%曾经发生过胃排空延滞,在其当中有5%~10%的病人发生过有感的临床表现。常因胃术后非机械性梗阻的流出道因素引起,故又被称为术后功能性胃瘫,是一种胃部手术后临床上常见的并发症。它会导致患者术后出现营养吸收障碍,以致恢复时间延长,医疗费用明显增加,对患者的心理产生不利影响,并有可能诱发其他并发症,甚至危及到患者的生命。胃瘫在临床上极易被诊断为机械性胃流出通道梗阻,若盲目采用手术治疗方式,极易产生病情的加重甚至延误最佳治疗时机。本文旨在通过收集我院胃肠外科一区行根治性远端胃大部切除术患者的临床资料,分析导致胃排空障碍的相关危险因素及总结治疗措施,为今后临床工作提供借鉴。方法:收集2010年1月至2014年12月就诊于福建医科大学附属第一医院胃肠一区行根治性远端胃大部切除术的病人的病案资料,采用回顾性分析方法,将21例发生PGS病人当做病例组,389例未发生PGS病人当做研究对照组。应用SPSS19.0软件先进行单因素χ2检验分析是否有统计学意义,后以是否发生PGS为应变量,可能影响PGS发生的13个因素为自变量进行赋值,应用非条件多元素Logistic回归模型进行,研究其对PGS的发生所产生的影响。结果:本研究经单因素χ2检验表明胃肠吻合方式、术前存在幽门梗阻、术前营养不良、术后开始肠内营养时间、术后腹腔并发症有统计学意义(P<0.05);经多因素Logistic回归分析结果表明:Billroth II式、术前幽门梗阻、术后开始肠内营养时间、术前营养不良、术后腹腔并发症是PGS发生的危险因素(OR>1,P<0.05)。结论:根治性远端胃大部切除术后PGS的发生与多种因素有关,Billroth II式、术前存在幽门梗阻、术后开始肠内营养时间、术前营养不良、术后腹腔并发症可能是术后胃瘫发生的危险因素,其中术后腹腔并发症是发生PGS的高危因素。积极处置上述高危因素可降低发生PGS的概率。胃瘫病人尽可能的采用保守治疗措施。更多还原

【Abstract】 Objective: PGS refers to the operation after the concurrency with gastric motor function as a poor clinical syndrome, often occurred in the patients after abdominal operation, simple gastrectomy in 10% ~ 25% had gastric emptying delay, 5% ~ 10% of the patients had clinical manifestations in the sense of. Often because of postoperative gastric mechanical obstruction of the outflow tract caused by factors, so it is also called functional gastric paralysis after operation, is a common clinical complication after operation on the stomach. It will lead to malabsorption after surgery, resulting in prolonged recovery time, medical costs increased significantly, adverse psychological effects on patients, cause unnecessary trouble, and may cause other complications, and even endanger the lives of patients. Gastroparesis in clinic is easily diagnosed as mechanical gastric outflow obstruction, if the blind use of operation treatment, prone to exacerbation of the disease and even delay the best treatment time. The purpose of this paper is to collect the clinical data by gastrointestinal surgery in our hospital area underwent radical distal gastrectomy patients, analyze the cause of the risk factors of gastric emptying and summarize the treatment measures, provide a reference for future clinical work.Methods:From 2010 January to 2014 December in Fujian Medical University Hospital Affiliated First Hospital of gastrointestinal area because of gastric cancer underwent radical resection of the distal gastrectomy in patients with clinical data, by retrospective analysis, 21 cases of PGS patients as case group, 389 cases occurred in PGS patients as study group. The application of SPSS 19 software were analyzed by single factor analysis of χ2 is statistically significant, as to whether the occurrence of PGS as the dependent variable, 13 possible risk factors for PGS variable assignment, non conditional Logistic regression model was applied to the elements, study the influence of PGS produced by.Results: This study by univariate test showed that 2 gastrointestinal anastomosis, preoperative pyloric obstruction, preoperative malnutrition, postoperative abdominal complications, postoperative enteral nutrition time had statistical significance(P<0.05); multivariate Logistic regression analysis showed that: Billroth II, preoperative, postoperative pyloric obstruction enteral nutrition time, preoperative malnutrition, abdominal complications after surgery are the risk factors of PGS(OR < 1, P < 0.05).Conclusion: Radical distal gastrectomy is related to multiple factors of PGS resection, Billroth II type, preoperative pyloric obstruction, postoperative enteral nutrition time, preoperative malnutrition, postoperative abdominal complications may be the risk factors of postoperative gastroparesis, abdominal postoperative complications were high risk factors PGS. The disposal of the positive risk factors can reduce the probability of occurrence of PGS. Gastroparesis patients as much as possible by conservative treatment.更多还原