胃手术后十二指肠残端漏的营养支持

目的总结胃远端切除术后十二指肠残端漏的营养支持经验,以提高十二指肠残端漏的治疗水平。方法对2005年1月—2009年12月,我院实施胃远端及全胃切除术后所发生的12例十二指肠残端漏（其中胃良性疾病3例;胃癌9例）病人的病况进行回顾性分析。结果8例于术后早期行十二指肠造口及腹腔引流术,采用持续胃肠减压,先给予肠外营养,然后实施从肠外营养支持逐步过渡到肠内营养支持的治疗手段。12例病人在肠外营养中强化了谷氨酰胺,10例使用了生长抑素,6例病人在十二指肠残端漏愈合期加用了生长激素。在首次胃手术后,2例漏口28～38 d自愈;10例漏口于2次手术后50～91 d愈合。其中1例因肺部感染合并严重的腹腔感染于首次术后31 d死亡。结论保证腹腔引流管通畅、持续胃肠减压,特别是肠外结合肠内营养支持、强化谷氨酰胺、生长抑素、生长激素等措施,是促进十二指肠残端漏愈合的重要手段。

Nutritional support to duodenal stump leakage after gastrectomy

Objective To summarize the experience in nutritional support to duodenal stump leakage after gastrectomy so as to increase the treatment of duodenal stump leakage.Methods A total of 12 patients with duodenal stump leakage following distal or total gastrectomy due to gastroduodenal ulcer（3 cases） and gastric carcinoma（9 cases） in the hospital from January 2005 to December 2009 were analyzed retrospectively.Results Eight cases were treated with duodenostomy and abdominal cavity drainage.In addition to continuous gastrointestinal and parenteral nutrition combined with enteral nutrition,all the 12 patients were given glutamine enrichment.Ten patients were infused somatostatin;6 ones were supplemented recombinant human growth hormone.Fistulae were healed in 2 patients 28-38 days later after initial gastrectomy and in 10 ones 50-91 days later after the second times operation.One complicated with severe sepsis due to thoracic,lung and abdominal cavity,and died 31 days later after gastrectomy for gastric carcinoma.Conclusion Treatment with duodenostomy,abdominal cavity drainage,continuous gastrointestinal decompression,parenteral and enteral nutrition,and administration of glutamine,somatostatin and recombinant growth hormone is the key to the patients of duodenal stump leakage after gastrectomy.