恶性梗阻性黄疸内引流术后胃瘫综合征临床分析

 目的 探讨恶性梗阻性黄疸病例胆肠吻合术后胃瘫综合征(PGS)的发病率以及危险因素.方法 回顾性分析因胆道良性疾病和恶性梗阻性黄疸而行胆肠吻合术病例137例,并就手术术式、术前胆红素水平、术前白蛋白水平与PGS发病率的关系进行分析.结果 (1)胆道良性疾病病例行胆肠吻合术后PGS发生率明显低于恶性梗阻性黄疸病例,分别为7.37%,21.43%(P<0.01).(2)PGS发生率与血清总胆红素水平有着明显的关系,9例PGS病例血清总胆红素均高于171 μmol/L(P<0.05).(3)PGS发生率与血清白蛋白水平有着明显的关系,随着低白蛋白血症的逐步加重,PGS发生率明显升高(P<0.01).(4)术前腹水与PGS发生率无明显相关性,有腹水者为23.08%,无腹水者为20.69%.结论 恶性梗阻性黄疸疾病背景、胆肠吻合手术、高胆红素血症及低蛋白血症均是PGS的高危因素.在恶性梗阻性黄疸患者中,单纯的T管引流术可以避免发生PGS;术前改善患者的高胆红素血症状态以及纠正患者的低蛋白血症,可能有利于降低PGS的发生率.

Postoperative gastroparesis syndrome after choledochojejunostomy for malignant obstructive jaundice

Objective To study the risk of postoperative gastmparesis syndrome （PGS） after choledeehojejunostomy for malignant obstructive jaundice.Methods The clinical data d 95 patients with benign obstruction of bihary duct （group A）and 42 patients with malignant obstructive jaundice （group B） treated operatively in this hospital since 2001 were analyzed retrospectively.Results （ 1）The rate of PGS after choledeehojejunostomy for benign obstructive jaur dice was lower than that for malignant obstructive jaundice, （7.37% vs 21.43% P 〈 0.01）. （2）All the 9 cases of PGS had hyper bilirubinewia 〉 171 μmol/L （ P 〈 0.05）, indicating the corretation between PGS and hyper bilimbinemia. （3）The PGS rate was highly related to hypoproteinemia; with aggravating hypoproteinemia, the PGS rate significantly increased （P〈0.01）.Conclusions The risks of PGS are malignant obstructive jaundice, choledeehojejunostomy, hyperbilirubinaemia, and hypopro-teinemia. Effectine correction of hgper bilirubinemia and hypoprotinemia before operation is beneficial to reduction of the PGS rate.