腹部手术后胃瘫综合征15例临床分析

目的探讨腹部手术后胃瘫综合征的病因,诊断和治疗方法。方法对1999-2008年我院腹部手术后胃瘫15例临床资料进行回顾性分析。结果本组共发生胃瘫15例,均发生于术后4-11d。病人经严格保守治疗,术后2-5周内全部治愈。结论腹部手术后胃瘫综合征的发生是多因素综合作用的结果,消化道造影及胃镜检查是主要的诊断方法,采用胃肠减压、营养支持、促动力药物的综合治疗是治疗腹部术后胃瘫的有效手段。应避免再手术。     

腹部术后胃瘫22例诊治体会

目的:探讨腹部手术后胃瘫综合征(PGS)的病因、诊断及治疗措施.方法:回顾性分析22例腹部手术后胃瘫的临床资料.结果:胃瘫多发生于腹部术后4～10 d.经综合治疗后胃肠动力一般可在6周内恢复.本组22例经非手术治疗均治愈出院.结论:胃手术后PGS治疗以综合性和保守治疗为主,尽量避免手术,以减轻患者痛苦.     

腹部术后胃瘫6例临床分析

目的：探讨腹部术后胃瘫的可能危险因素、诊断及治疗方法。方法：对6例腹部术后胃瘫患者的潜在危险因素、临床表现、诊断方法、治疗手段进行回顾性分析。结果：本组中胃瘫患者采用非手术疗法均治愈，疗程7-46天。经保守治疗后胃肠动力一般可在术后7周内恢复正常。结论：胃瘫由多种因素诱发，诊断时必须排除机械性、器质性病变。胃镜、上消化道造影是诊断本病有价值的方法。采用促动力药物在内的保守支持治疗是治疗腹部术后胃瘫的有效手段，应避免再手术。     

胃瘫33例诊治体会

目的探讨腹部手术后胃瘫的发病机制、诊断和治疗。方法对33例腹部手术后胃瘫综合征患者的临床资料进行分析。结果 31例病例经营养支持、药物治疗痊愈,2例好转。结论胃肠手术后胃瘫是由综合因素所致,采取非手术疗法基本可治愈,营养支持是治疗的关键。     

腹部手术后胃瘫45例分析

目的 总结腹部手术后胃瘫的诊治经验.方法 回顾性分析2005年1月至2011年12月期间45例腹部手术后胃瘫患者的临床资料.结果 45例均治愈,仅1例再次手术.结论 腹部手术后胃瘫宜采用非手术治疗.     

腹部手术后胃瘫综合征的诊治分析

目的探讨腹部手术后胃瘫综合征患者的临床特点、诊断方法以及治疗方法。方法将12例腹部手术后胃瘫患者为资料,分析出现胃瘫综合征的原因,并给予促胃动力药等积极的治疗。结果经过治疗后12例患者均在9周内恢复正常。结论年龄、麻醉以及术后使用自控镇痛泵等均是导致胃瘫发生的原因,需要给予综合的治疗促进患者的康复。     

胃部手术后胃瘫综合征20例临床分析

目的:探讨胃部手术后胃瘫综合征的原因,诊断和治疗.方法:时1995-2006年我院胃部手术后胃瘫20例临床资料进行回顾性分析.结果:本组共发生胃瘫20例,均发生于术后3～10d.病人经严格保守治疗,70%于术后3周内治愈,31d内全部治愈.结论:术后胃瘫综合征是胃部手术后继发的以胃排空障碍为主要特点的胃动力紊乱综合征,易与机械性梗阻混淆,往往延长术后恢复时间并会增加治疗费用.消化道造影及胃镜检查是主要的诊断方法.采用保守治疗一般均可治愈,不需再次手术.     

腹部手术后胃瘫13例临床分析

目的 :探讨腹部手术后胃瘫发生的原因、诊断与治疗。方法 :对1998年1月～2002年12月腹部手术后发生胃瘫的临床资料进行比较、分析。结果 :共发生胃瘫13例。1例怀疑吻合口梗阻再次手术 ,术后恢复时间更长 ,余12例采取保守治疗而治愈。结论 :胃瘫的发生是多因素的 ,消化道造影及胃镜检查是诊断胃瘫的重要手段 ,胃瘫确诊后应采取保守治疗 ,避免再次手术。     

手术后胃瘫综合征的诊疗体会

目的探讨腹部手术后胃瘫综合挣的发病机制、诊断及治疗效果。方法对我院2001年1月～2008年12月收治的17例胃瘫综合挣的临床资料进行回顾性分析总结。结果 17例均经非手术治疗治愈。结论腹部手术后胃瘫综症的诊断主要依据临床表现、胃镜检查及消化道造影;采取保守治疗的效果满意,极少需要手术治疗。     

腹部手术后胃瘫综合征12例诊治分析

目的 探讨腹部手术后胃瘫综合征(postsurgicat gasstroparesis syndrome,PGS)的病因、诊断及治疗方法.方法 回顾性分析2005年1月至2010年12月收治的26例PG-S患者的临床资料.结果 26例患者均经胃肠减压、营养支持,给予胃动力药、心理干预等综合治疗后痊愈.治愈时间3周14例(53.85％),4周8例(30.77％),5～7周4例(15.38％).结论 腹部手术后PGS的发生是多因素作用的结果,上消化道造影及胃镜检查是诊断PGS的可靠方法,保守治疗为其主要治疗手段.     

胃切除术后胃瘫24例分析

目的 探讨胃部分切除术后胃瘫发生机制、诊断及治疗。方法 对24例胃切除术后胃瘫患者进行回顾性分析。结果 24例胃瘫病人经非手术治疗均获得痊愈。结论 胃瘫发生原因与多种因素有关，经确诊后，只需行非手术治疗即获治愈。     

腹部手术后功能性胃排空障碍的诊断和治疗

目的：探讨腹部手术后功能性胃排空障碍的病因、诊断和治疗。方法：对1995年5月～2005年5月收治的30例腹部手术后胃排空障碍的临床资料进行回顾性分析。结果：功能性胃排空障碍发生于腹部手术后3～14天。本组经非手术治疗于术后7～30天恢复胃动力，均痊愈出院。结论：腹部手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本病的重要方法。采取非手术疗法可治愈胃排空障碍，尽量避免再次手术。     

胃癌根治术后胃瘫的诊治分析

目的总结胃癌根治术后胃瘫的诊断和治疗方法。方法对胃癌根治术后发生21例患者诊治过程进行回顾性分析。结果胃瘫的临床表现为上腹部持续性饱胀、钝痛,伴呕吐带有食物和胆汁的胃液,行上消化道造影示:残胃扩张、蠕动波少且弱,胃肠吻合口通过欠佳;胃镜示:吻合口通畅。经禁食、胃肠减压、营养支持并给予胃肠动力促进剂后,21例均得到缓解。结论上消化道造影和胃镜是诊断本病的重要方法,采用保守治疗均可治愈。     

中西医结合治疗腹部非胃术后胃瘫20例临床体会

目的：探讨腹部非胃手术后胃瘫的中西医结合治疗。方法：对20例腹部非胃手术后胃瘫患者在常规西医治疗基础上,从鼻肠营养管或胃管注入中药和胃理气汤约30ml,每日3次。结果：20例均痊愈,治疗时间7～25d,平均14.3d,治疗后正常胃电节律明显高于治疗前（P〈0.01）,1～2年内随访18例,均饮食正常,症状无复发。结论：腹部非胃手术胃瘫治疗应以中西医结合治疗,并注重心理治疗的作用。     

Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis

BACKGROUND: Uncontrolled studies suggest benefit of intrapyloric injection of botulinum toxin (botox) for the treatment of gastroparesis, but controlled data are lacking. AIM: To perform a controlled study of botox injection in gastroparesis. METHODS: Twenty-three gastroparesis patients (five men, age 45 +/- 3, 19 idiopathic) underwent two upper endoscopies with 4-week interval, with injection of saline or botox 4 x 25 U in a randomized double-blind-controlled crossover fashion. Before the start of the study and 4 weeks after each treatment, they underwent a solid and liquid gastric emptying breath test with measurement of meal-related symptom scores, and filled out the Gastroparesis Cardinal Symptom Index. Results (mean S.E.M.) were compared using Student's t-test. RESULTS: Twelve patients received botox and 11 saline as the first injection. Significant improvement in emptying and Gastroparesis Cardinal Symptom Index was seen after initial injection of saline or botox. No further improvement occurred after the second injection (respectively, botox and saline). Pooled data for both treatment groups showed no significant difference in improvements of solid t(1/2) (3.4 +/- 7.4 vs. 16.3 +/- 8.3, N.S.) and liquid t(1/2) (8.2 +/- 13.7 vs. 22.5 +/- 7.7, N.S.), meal-related symptom scores or Gastroparesis Cardinal Symptoms Index (GCSI; 6.1 +/- 1.5 vs. 3.8 +/- 1.5, N.S.). CONCLUSION: In a cohort of predominantly idiopathic gastroparesis patients, botox is not superior to placebo in improving either symptoms or the rate of gastric emptying.     

Development and content validity of a gastroparesis cardinal symptom index daily diary

Background  The Gastroparesis Cardinal Symptom Index (GCSI) is a patient-reported outcome for gastroparesis using a two-week recall period. To minimize potential patient recall effects, a daily diary version of the GCSI (GCSI-DD) was developed.
Aims  To evaluate the content validity of GCSI-DD for the symptoms in patients with documented gastroparesis, to capture symptom variability over time and to compare responses of this GCSI-DD to the original GCSI.
Methods  In gastroparesis adults with delayed gastric emptying, cognitive debriefing interviews were conducted to elicit their perspective on relevant symptoms of gastroparesis and relevant recall periods and to evaluate patient understanding of GCSI-DD. Patients completed the GCSI-DD daily over a 2-week period and completed the GCSI at baseline and the 2-week follow-up visit.
Results  Twelve gastroparesis patients, of whom five were diabetic and nine women, reported nausea (100%), vomiting (100%), stomach fullness (75%), bloating (58%) and loss of appetite (50%) were important symptoms. All patients understood diary instructions and item content and reported that the diary captured their gastroparesis symptom experience; 83% considered response scales adequate. There was significant daily variability in GCSI-DD scores. Mean GCSI-DD subscale and total scores over 2 weeks correlated strongly (all r  > 0.90) with GCSI scores at 2-week follow-up.
Conclusions  The GCSI-DD includes symptoms relevant to patients with gastroparesis, captures daily variability of those symptoms and has psychometric properties consistent with a good patient-reported outcome endpoint for gastroparesis clinical trials.     

胃肠手术后胃瘫综合征的诊疗分析

目的探讨胃肠手术后胃瘫综合征诊断方法和治疗效果。方法对我院胃肠手术后发生胃瘫综合征的患者33例的临床资料进行分析,探讨胃肠手术后胃瘫综合征诊断方法和治疗效果。结果 胃肠造影和胃镜检查,是胃肠手术后胃瘫综合征的主要诊断方法 ;胃瘫综合征多发生于胃肠术后3⁷ d;33例患者中,给予保守的综合治疗后,胃肠功能均有明显的恢复,没有需要再次手术治疗的患者,患者恢复半流食1周后所有患者均未复发,全部出院。胃动力恢复时间107 d;33例患者中,给予保守的综合治疗后,胃肠功能均有明显的恢复,没有需要再次手术治疗的患者,患者恢复半流食1周后所有患者均未复发,全部出院。胃动力恢复时间10²6 d,平均(18.96±2.46)d。结论给予胃肠手术后胃瘫综合征患者保守的综合治疗,可以取得良好的治疗效果,避免再次进行手术,值得临床推广。     

Current concepts in diabetic gastroparesis

Diabetic gastroparesis is a common and debilitating condition affecting millions of patients with diabetes mellitus worldwide. Although gastroparesis in diabetes has been known clinically for more than 50 years, treatment options remain very limited. Until recently, the scientific literature has offered few clues regarding the precise aetiology of gastric dysfunction in diabetes.Up to 50% of patients with diabetes may experience postprandial abdominal pain, nausea, vomiting and bloating secondary to gastric dysfunction. There is no clear association between length of disease and the onset of delayed gastric emptying. Gastroparesis affects both type 1 (insulin dependent) and type 2 (non- insulin dependent) forms of diabetes. Diagnosis requires identifying the proper symptom complex, while excluding other entities (peptic ulcer disease, rheumatological diseases, medication effects). The diagnosis of gastroparesis may be confirmed by demonstrating gastric emptying delay during a 4-hour scintigraphic study. Treatment options are limited and rely on dietary modifications, judicious use of available pharmacological agents, and occasionally surgical or endoscopic placement of gastrostomies or jejunostomies. Gastric pacing offers promise for patients with medically refractory gastroparesis but awaits further investigation. Current pharmacological agents for treating gastroparesis include metoclopramide, erythromycin, cisapride (only available via a company-sponsored programme) and domperidone (not US FDA approved). All of these drugs act as promotility agents that increase the number or the intensity of gastric contractions. These medications are not uniformly effective and all have adverse effects that limit their use. Cisapride has been removed from the open market as a result of over 200 reported cases of cardiac toxicity attributed to its use. Unfortunately, there is a paucity of clinical studies that clearly define the efficacy of these agents in diabetic gastroparesis and there are no studies that compare these drugs to each other. The molecular pathophysiology of diabetic gastroparesis is unknown, limiting the development of rational therapies. New studies, primarily in animals, point to a defect in the enteric nervous system as a major molecular cause of abnormal gastric motility in diabetes. This defect is characterised by a loss of nitric oxide signals from nerves to muscles in the gut resulting in delayed gastric emptying. Novel therapies designed to augment nitric oxide signalling are being studied.     

Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index

BACKGROUND: Patient-based symptom assessments are necessary to evaluate the effectiveness of medical treatments for gastroparesis. AIM: To summarize the development and measurement qualities of the Gastroparesis Cardinal Symptom Index (GCSI), a new measure of gastroparesis-related symptoms. METHODS: The GCSI was based on reviews of the medical literature, clinician interviews and patient focus groups. The measurement qualities (i.e. reliability, validity) of the GCSI were examined in 169 gastroparesis patients. Patients were recruited from seven clinical centres in the USA to participate in this observational study. Patients completed the GCSI, SF-36 Health Survey and disability day questions at a baseline visit and again after 8 weeks. Clinicians independently rated the severity of the patients' symptoms, and both clinicians and patients rated the change in gastroparesis-related symptoms over the 8-week study. RESULTS: The GCSI consists of three sub-scales: post-prandial fullness/early satiety, nausea/vomiting and bloating. The internal consistency reliability was 0.84 and the test-re-test reliability was 0.76 for the GCSI total score. Significant relationships were observed between the clinician-assessed symptom severity and the GCSI total score, and significant associations were found between the GCSI scores and SF-36 physical and mental component summary scores and restricted activity and bed disability days. Patients with greater symptom severity, as rated by clinicians, reported greater symptom severity on the GCSI. The GCSI total scores were responsive to changes in overall gastroparesis symptoms as assessed by clinicians (P = 0.0002) and patients (P = 0.002). CONCLUSION: The findings of this study indicate that the GCSI is a reliable and valid instrument for measuring the symptom severity in patients with gastroparesis.