胃大部切除术后胃瘫的诊断和治疗

目的 探讨胃大部切除术后胃瘫的发生原因、诊断及治疗。方法 对1990年-2002年302例施行胃大部切除术的临床资料进行回顾性分析。结果 本组共发生胃瘫18例(5．96％)，均发生于术后3-10d，所有患者均经保守治疗痊愈出院。1w内治愈2例(11．11％)，2w内治愈5例(27．78％)，3w内治愈11例(61．11％)。结论 术后残胃和远端空肠正常的运动功能破坏是发生胃瘫的主要原因。胃镜X线检查是胃瘫诊断与机械性肠梗阻鉴别的主要方法。采取非手术治疗一般均可治愈，针对胃排空动力学机制的改变，采用促胃肠动力药物可能收到较好的疗效。

Diagnosis and treatment of gastroparesis after subtotal gastrectomy

Objective To investigate the possible causes of gastroparesis and its diagnosis and treatment. Methods The clinical data of 302 patiants received subtotal gastrectomy from 1990 to 2002 were retrospestively analysed. Results Gastroparesis occurred in 18 of 302 patients(59.6%) within 3 to 10 days after sugery. All the 18 patients recovered completely with conservative treatment and were discharged. Among the 18 patients, two (11.11%) recovered in 1 week, five (27.78%) did in 2 weeks, 11(61.11%) did in three weeks .Conclusion Residual stomach and damage of normal motor function of distal jejunum were the main cause of gastroparesis. Gastroscopy and X - ray were the main methods of diagnosis of gastroparesis and differential diagnosis with mechanical ileus. All the gastroparesis chould be cured with non - operation treatment, and according to changes of dynamic mechanism of gastro - evacuation , uses of prokinetic drugs have beneficial effects.