腹腔非胃手术后胃瘫综合征22例的临床分析

目的 探讨腹腔非胃手术后胃瘫综合征的病因、诊断与治疗。方法回顾性分析1972年至2004年间22例腹腔非胃手术后胃瘫综合征患者的临床资料。结果22例患者在手术后4-6d进食后出现上腹膨胀、恶心呕吐，吐物含有胆汁性胃液及食物。检查均发现上腹膨满、振水音明显和肠鸣音减弱。胃肠减压管每天可吸出1000-3000ml胆汁样胃液。行胃造影（稀钡或60％泛影葡胺）22例均显示胃无蠕动，呈松弛、静止状态；观察5—6h造影剂仍滞留胃内。予以持续胃肠减压、营养支持和维持水电解质、酸碱平衡；采用促进胃肠动力药物等非手术治疗；100％的患者于胃瘫发生后5—25（平均14．2）a恢复胃动力。结论腹腔非胃手术后胃瘫综合征是多种因素所致胃功能改变，经非手术可以治愈。

Clinical analysis of gastroparesis syndrome after nongastrectomy abdominal operation: a report of 22 cases

Objective To investigate the causes, diagnosis and treatment of gastroparesis syndrome after nongastrectomy abdominal operation. Methods The clinical data of 22 cases with gastroparesis syndrome after nongastrectomy abdominal operation from 1972 to 2004 were retrospectively analyzed. Results Gastroparesis syndrome after nongastrectomy abdominal operation often occurred during 4 - 6 days postoperatively when the patients began to take in food, characterized by upper abdominal distension, nausea, vomiting, strong splashing bowel sound, weak bowel sound and large quantity of gastric drainage ranging from 1000 to 3000 ml every day. Barium meal was valuable not only in the diagnosis but also effective for promoting gas motility. It revealed a non-peristaltic, flabby and static stomach, and retention of contrast medium in the stomach even 5 -6 hours later. All the patients recovered through non-operative therapy for 5-25 days including continuous gastrointestinal decompression, TPN and gastro-intestinal dynamic medicine. Conclusion The causes of gastroparesis syndrome after nongastrectomy abdominal operation are muhifactorial, most of such patients can be cured by non-operative therapy.