胰十二指肠切除术后胃瘫综合征的综合治疗

目的探讨胰十二指肠切除术后胃瘫综合征(gastroparesis syndrome,GS)的综合治疗。方法回顾性分析南充市中心医院2011年1月至2016年1月期间完成的胰十二指肠切除术108例,其中术后发生胃瘫综合征43例,均根据临床表现、泛影葡胺上消化道造影及胃镜检查确诊。按照国际胰腺外科学研究小组胃瘫分级诊断标准,其中A级35例,B级8例。给予常规治疗、持续胃肠减压、安置空肠营养管肠内营养支持、改善胃动力及中药针灸综合治疗,观察治疗效果。结果术后胃动力恢复时间为术后2~4周,35例A级患者于术后2周内恢复;B级6例患者于术后3周内恢复,2例于术后4周内恢复,平均病程13.5 d。均治愈,无再次手术者,均无胰瘘、吻合口瘘等严重并发症发生。门诊随访3~6个月无再次胃瘫发生。结论胰十二指肠切除术后胃瘫综合征采取综合治疗是安全有效的。

Comprehensive treatment on gastroparesis syndrome after pancreatoduodenectomy

Objective To investigate comprehensive treatment on gastroparesis syndrome after pancreato-duodenectomy. Methods A total of 108 patients with pancreatoduodenectomy between Jan. 2011 and Jan. 2016 in Nanchong Central Hospital were analyzed retrospectively. Among them 43 cases had occured gastric paralysis syndrome which confirmed by the clinical manifestation, the general influence of the upper gastrointestinal tract radiography and gastroscopy. According to the classification of International Study Group of Pancreatic Surgery, 35 cases in Grade A and 8 cases in Grade B. Comprehensive treatment included routine treatment, continuous gastrointestinal decompression, enteral nutrition support in the jejunum nutrition tube, improving gastric motility, the traditional Chinese medicine and acupuncture were given, and the clinical effect in all patients were observed. Results The recovery time of gastric motility were 2 to 4 weeks after operation, 35 cases (Grade A) recovered within 2 weeks, 6 cases (Grade B) recovered within 3 weeks, 2 case (Grade B) recovered within 4 weeks, and the average course of disease was 13.5 d. All patients were cured and no reoperation and serious complications hap-pened such as pancreatic fistula and anastomotic leakage. The outpatient follow-up were made for 3~6 months and no recurrence of gastroparesis was found. Conclusion Comprehensive treatment is safe and effective to treat gastroparesis syndrome after pancreatoduodenectomy.