胃癌术后残胃排空障碍的治疗体会

胃大部切除术后残胃排空障碍亦称胃瘫 ,是指不伴有机械性梗阻因素残胃动力紊乱综合征 ,主要由于残胃无力收缩 ,排空迟缓而致胃扩张等一系列病理生理改变。该并发症是胃大部切除术后常见的并发症之一 ,发生率为 3%～ 4 % [1] 。本院自 1995年 3月～ 2 0 0 1年 5月共收治胃癌术后残胃排空障碍症患者 38例 ,其中 8例由外院转人。本组患者明确诊断后均给予保守治疗 ,取得了满意的效果。现将治疗体会介绍如下。1　临床资料1 1　一般资料本组患者 38例 ,其中男 2 9例 ,女 9例 ,年龄 32～76岁 ,平均年龄 5 6岁。均为胃癌胃大部切除术后 ,主要表现为…     

食管贲门癌术后早期胸胃排空障碍的原因分析（附13例报告）

食管贲门癌切除、胃或残胃代食管术是最常用的手术方式,由于胃的位置发生变化及手术的各种原因而导致术后早期胸胃排空障碍.据报告发生率一般为0.1%～1.3%我院自1983年以来共发生术后早期胸胃排空障碍患者13例,本文结合临床资料对胸胃排空障碍可能的原因进行探讨.1 临床资料13例患者中,男性11例,女性2例;年龄56～71岁,平均年龄58.6岁.食管癌8例,贲门癌5例;均在全麻下行左后外侧切口,食管癌经第六肋间或第六肋床进胸,贲门癌经第七肋间或第七肋床进胸.消化道重建采用食道胃主动脉弓后上吻合术者9例,弓前上吻合术者2例,食管残胃吻合术者5例.术后发生胸胃排空障碍时间:术后3天7例、5天4例、7天2例.症状与体征:术后3天停胃肠减压,经胃管滴入清流质后患者逐渐出现胸闷、气短、呼吸困难(食管癌者更为明显),多数患者伴有不同程度的呕吐,吐物多为咖啡色胃液,吐后症状缓解.术侧听诊     

食管癌、贲门癌术后胸胃排空障碍的诊断和治疗

目的:探讨食管癌、贲门癌术后胸胃排空障碍的发生原因、诊断和治疗.方法:对1997年1月到2001年12月五年间施行1861例食管癌、贲门癌切除术的病人临床资料进行回顾性分析.结果:本组病例发生胸胃排空障碍27例,发生率1.45%,其中机械性胸胃排空障碍6例,功能性胸胃排空障碍21例,均发生于术后3天～12天,再次手术治疗8例;治愈26例,死亡1例.结论:鉴别胃排空障碍是由机械性还是功能性引起的尤为重要,上消化道造影、胃镜检查是鉴别两者的重要方法.对食管癌、贲门癌术后功能性胃排空障碍应采取保守治疗,而由机械性原因所致,一旦确诊应立即手术.     

胃癌手术后残胃排空延迟症8例分析

胃癌术后残胃排空延迟症是一种功能性病变，一般采用保守治疗。我们自1986年以来遇到胃癌手术后残胃排空延迟症8例，现分析如下：1资料8例中男性5例，女性3例。年龄34岁～76岁，平均52．6岁。胃癌根治术7例，姑息性胃切除1例，消化道重建方式BilLrothl式3例、！式结肠前5例。术后3～4天肠鸣音仍微弱，大量胃液引出，夹闭胃管即腹胀、呕吐2例。5例顺利于3～4天后拔胃管进流质后仍出现腹胀呕吐。另1例已过半流质时仍有上述症状。经X线初冬或碘油造影6例、胃镜2例，均诊为残胃乏力症。经保守治疗分别于8～10天缓解4例，11～14天3例。1例22天…     

食管癌切除术后胃排空障碍的原因及防治

 目的　探讨食管癌切除术后胃排空障碍的原因及防治措施。方法　对食管癌术后并发胃排空障碍 17例患者的临床资料进行回顾性分析。结果　本组均发生于术后 7～ 12天 ,其中 12例功能性胃排空障碍经保守治疗 ,治愈 11例 ,死亡 1例 ,5例机械性胃排空障碍均经手术治愈 ,本组死亡率为 5 .88%。结论　迷走神经切断及胃解剖位置的变化是胃排空障碍的主要原因 ,其次胃排空障碍也与胃扭转、术后粘连等因素有关。X线钡剂造影及胃镜检查是诊断本病的主要方法。功能性胃排空障碍 ,一般行保守治疗 ;机械性胃排空障碍 ,应尽早手术。术前充分准备 ,手术操作认真、规范 ,术后恰当处理 ,可减少胃排空障碍的发生     

中西医结合治疗胃切除术后残胃排空障碍

残胃排空障碍是胃切除术后早期少见的并发症 ,常误认为机械性梗阻而行不必要的手术探查。临床上处理起来比较棘手 ,单用西药治疗不甚理想 ,笔者对我院 1985年以来胃癌、贲门癌术后所发生的残胃排空障碍 17例、胃壁切开术后排空障碍 1例 ,用中西结合的方法进行治疗 ,疗效满意 ,分析如下。临床资料一、一般资料 :本组 18例。男 15例 ,女 3例 ,年龄为 2 3～ 70岁 ,胃癌 11例 ,贲门癌 6例 ,胃石症 1例。二、手术类型 :胃大部切除Ｂ 1式手术 3例 ,Ｂ 2式手术 8例 ,近端胃大部切除 8例 ,远端胃大部切除 9例 ,胃前壁切开取石 1例。三、诊断 :多在术…     

食管癌、贲门癌术后胸胃排空障碍的诊断和治疗

目的：探讨食管癌、贲门癌术后胸胃排空障碍的发生原因、诊断和治疗。方法：对1997年1月到2001年12月五年问施行1861例食管癌、贲门癌切除术的病人临床资料进行回顾性分析。结果：本组病例发生胸胃排空障碍27例，发生率1．45％，其中机械性胸胃排空障碍6例，功能性胸胃排空障碍21例，均发生于术后3天～12天，再次手术治疗8例；治愈26例，死亡1例。结论：鉴别胃排空障碍是由机械性还是功能性引起的尤为重要，上消化道造影、胃镜检查是鉴别两者的重要方法。对食管癌、贲门癌术后功能性胃排空障碍应采取保守治疗，而由机械性原因所致，一旦确诊应立即手术。     

胃癌术后功能性排空障碍的原因及对策

胃切除术后排空障碍分为机械性和功能性两种,对前者需再手术治疗,而对后者的处理方法则有其独特性,由于处理方法截然不同,因此鉴别诊断很重要.现仅将我院1970年～1996年胃癌术后发生23例功能性排空障碍的原因及其对策报告如下:1临床资料1.1一般资料 本组行胃癌根治术653例患者中,术后发生功能性排空障碍者23例,占3.5%.男20例,女3例;年龄为30岁～72岁.胃癌20例,贲门癌3例.1.2手术方式 胃大部切除B—Ⅰ式3例,B—Ⅱ式或Rouy—Y吻合术17例,近端胃切除3例.1.3临床诊断 多在胃肠功能已恢复(肛门已排气),进食3～11天后,突然发生进食困难,呕吐,呕出物以液体和胆汁为主,持续时间为7～40天.上消化道钡餐X线透视发现残胃有液体潴留,钡剂通过吻合口到肠道缓慢,残胃蠕动减弱;胃镜检查无任何机械性梗阻.除外机械性排空障碍.     

贲门癌术后残胃功能性排空障碍的诊断和治疗

目的 探讨贲门癌术后功能性胃排空障碍(FDGE)的病因、发生机制、诊断和治疗方法.方法 对1993年5月至2007年12月该院收治的307例贲门癌术后胃排空障碍的临床资料进行回顾性分析.结果 功能性胃排空障碍均发生于手术后5～12 d.经胃肠减压,营养支持,维持水、电解质代谢平衡及促进胃肠动力药物等治疗均得以缓解.结论 贲门癌术后功能性胃排空障碍的病因是多因素的,消化道造影及胃镜检查是诊断胃排空障碍及鉴别机械性梗阻的重要手段.采取非手术疗法可以治愈,应尽量避免再次手术.     

食管癌、胃癌切除术后胃排空障碍(附31例临床分析)

胃排空障碍是食管癌、胃癌切除术后比较常见的并发症之一。随着医学技术的迅猛发展及基础研究的不断深入 ,人们对食管癌、胃癌切除术后胃排空障碍的认识 ,已从器官、组织水平发展到细胞、基因水平阶段。医学研究逐步深入 ,临床经验的不断积累 ,新药的广泛研制、开发和利用 ,胃排空障碍的发生率逐年下降。现将我院 1988年 8月 - 2 0 0 1年12月 ,31例食管癌、胃癌切除术后胃排空障碍的原因及防治体会报道如下。1　临床资料本组男性 17例 ,女性 14例。年龄 43岁～ 76岁。其中食管癌术后 17例 ,既 :膈疝 3例 ,胃扭转 5例 ,经右胸食管癌切除、十…     

Gastric cancer

To prove the efficacy of adjuvant therapy for curatively resected advanced gastric cancer, large-scale randomized control trials are necessary based on the idea of EBM (Evidence Based Medicine). We had a long history of adjuvant therapy and many trials were conducted so far. However, many problems were also pointed out in past trials, even in the several trials with positive results. After accumulation of the knowledge of a good clinical trial, we started to organize study groups like JCOG (Japan Oncology Group) for high-quality clinical trials in Japan. The positive result of the National Surgical Adjuvant Study of Gastric Cancer (N. SAS-GC) is encouraging after the long period of negative results from adjuvant trials. This trial was well designed randomized clinical trial (RCT) with statistically significant difference of survivals,which suggest the efficacy of the adjuvant chemotherapy with UFT. However, because of the reduced sample size of this trial, we need one more trial with sufficient sample size to prove the efficacy of adjuvant chemotherapy for gastric cancer as the definitive evidence.     

Gastric adenocarcinoma

In spite of the declining incidence of gastric adenocarcinoma observed during the last 30 years in the U.S., this disease continues to carry a very bleak prognosis. Even with the best forms of treatment, the overall survival remains approximately 7%.Epidemiologic data within the past decade have given considerable new insight into the carcinogenesis of gastric cancer in high-risk areas worldwide as it relates to in vivo nitrate conversion to precarcinogens or carcinogenic substances. It is hope that further epidemiologic information will help to identify specific preventive measures to eliminate those environmental dietary factors that contribute to the incidence of gastric cancer in certain endemic areas.The only hope for cure after a diagnosis of gastric cancer is established lies with an extirpative surgical procedure possibly combined with an adjuvant chemotherapeutic regimen. In the presence of incurable disease, the best form of palliation is achieved with resection of the primary tumor, short of total gastrectomy. Palliative bypass procedures do not increase survival and any hope of improving the quality of life is highly question-able.Adjuvant forms of therapy using the known chemotherapeutic agents active against gastric adenocarcinoma provide the most likely means of improving survival associated with gastric cancer.     

Gastric carcinoma

Although gastric cancer is still a worldwide major public health concern, it remains relatively uncommon in the Western countries. Despite improvement in surgical morbidity and mortality, as well as significant advancement of chemotherapy and radiotherapy options, the survival for gastric cancer has not significantly improved over the past decades. In the United States, standard of care for localized resectable gastric cancer is with adjuvant chemoradiotherapy. In this article, we summarize salient randomized and phase II and III clinical trials representing current treatment for gastric cancer.     

Gastric cancer

With the development of related instruments and techniques, laparoscopic surgery has come to be applied to treatment of gastrointestinal malignancies as a minimally invasive surgery. For early gastric cancers with negligible risk of lymph node metastasis, endoscopic mucosal resection (EMR), laparoscopic wedge resection (LWR), and laparoscopic intragastric mucosal resection (IGMR) have been performed. For those with fairly sizable risk of lymph node metastasis, laparoscopy-assisted distal gastrectomy (LADG) is applied. Our studies have suggest that LADG is more useful than open distal gastrectomy in the management of patients with gastric cancer from the viewpoints of curability, minimal invasiveness, and quality of life of patients.     

Gastric carcinoid

PURPOSE OF REVIEW: Gastric carcinoid tumors are rare lesions but have been the focus of much scientific investigation. The incidence of gastric carcinoid appears to be increasing without a corresponding increase in survival, despite utilization of the latest available therapies. Therefore, there is great interest in furthering the understanding of the biologic basis of these tumors, delineating the connection between hypergastrinemia and gastric carcinoids, and most importantly, improving upon current treatment options. RECENT FINDINGS: This review discusses the current biologic understanding of gastric carcinoid tumors, including the role of hypergastrinemia on enterochromaffin-like cell proliferation and its relation to acid-suppressive therapy. Numerous diagnostic and therapeutic modalities including endoscopic ultrasound, somatostatin receptor scintigraphy, long-acting octreotide, hepatic artery embolization, endoscopic mucosal resection, and surgical resection have also been the focus of recent investigations. SUMMARY: Despite the many advances that have been made in both the basic science and clinical arenas, the optimal treatment of gastric carcinoid tumors is still a matter of debate. As the understanding of the biologic basis of gastric carcinoid tumors increases, the treatment will likely be a multimodal approach tailored to individual tumor biology and will incorporate a variety of diagnostic and therapeutic modalities.