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目的探讨食管癌、贲门癌根治术后胃瘫的发病因素及治疗措施。方法回顾分析济源市人民医院自2003年8月至2009年10月30例术后胃瘫综合征(PGS)患者的临床资料。结果本组30例患者经处理,腹胀、呕吐症状消失,胃肠减压引流量逐渐少于400ml/d,在19～38d上消化道造影证实胃肠蠕动好,给予拔管进食。其中有2例出现胃液反流,呛入肺内,导致吸入性肺炎,给予及时抢救,加强抗感染,病情得到控制,最终痊愈。本组无1例死亡,均痊愈出院,平均住院15～85d。结论食管、贲门癌术后发生胃瘫,如处理不当可严重影响患者的心肺功能、导致低蛋白血症、电解质紊乱,引起一系列呼吸循环生理改变,迁延不愈可致死亡。术前要做好患者的思想工作,以消除其紧张情绪,使其积极配合治疗;术中操作时要轻柔,避免过度牵拉或挤压胃壁;游离胃既要充分又要避免过度,在胃长度足够吻合时避免游离十二指肠;在符合肿瘤切除原则的前提下,尽量选择作胸项吻合,少作颈部吻合可避免对胃的过度牵拉;术后要进行充分的胃肠减压,维持水、电解质平衡,加强营养支持治疗、饮食调理得当,以促进患者早日康复。
Objective To investigate the etiological factors and treatment of gastroparesis after radical resection of esophageal and cardiac cancer. Methods The clinical data of 30 patients with postoperative gastroparesis syndrome (PGS) from August 2003 to October 2009 in Jiyuan People’s Hospital were retrospectively analyzed. Results The group of 30 patients treated, bloating, vomiting disappeared, gastrointestinal decompression drainage gradually less than 400ml / d, 19 ~ 38d on the gastrointestinal gastrointestinal imaging confirmed good peristalsis, given extubation eating. Among them, 2 cases had reflux of gastric fluid, choking into the lungs, leading to aspiration pneumonia, giving timely rescue, strengthening anti-infection, getting the disease under control and eventually recovering. No one died in this group, were cured and discharged, the average hospital 15 ~ 85d. Conclusions Gastroparesis occurs after esophageal and cardial cancer surgery. Improper treatment can seriously affect the cardiopulmonary function of the patients, leading to hypoalbuminemia and electrolyte imbalance, causing a series of respiratory cycle physiological changes, which may lead to death after prolonged unhealed. Before surgery to do the patient’s ideological work to eliminate the tension, so that it actively cooperate with the treatment; intraoperative operation to be gentle, to avoid excessive stretch or squeeze the stomach; free stomach should be sufficient and to avoid excessive, in the stomach Length consistent enough to avoid free from the duodenum; in line with the principle of tumor resection, try to choose for chest anastomosis, less neck anastomosis to avoid excessive traction on the stomach; to be adequate after gastrointestinal subtraction Pressure, maintain water and electrolyte balance, strengthen nutrition supportive treatment, proper diet, to promote the early recovery of patients.