胃癌根治性远侧胃切除术后胃瘫综合征的病因探讨

目的:探讨胃癌根治性远侧胃切除术后胃瘫综合征的发病原因。方法:回顾性分析兰州军区总医院1990年1月-2005年12月因胃癌行根治性远侧胃切除术456例的病历资料。结果:根治性远侧胃切除术456例,发生胃瘫综合征9例(1.97%)。贫血、低蛋白血症和血红蛋白、血浆蛋白正常者胃瘫综合征的发生率无显著差异;幽门梗阻者术后胃瘫的发生率明显高于无幽门梗阻者。X-ray造影和胃镜检查都显示残胃排空障碍、无蠕动;残胃黏膜高度水肿、吻合口被黏膜遮蔽者6例(66.67%);残胃扩张、松软无力、胃黏膜水肿较轻,吻合口未遮蔽者3例(33.33%)。结论:胃癌根治性远侧胃切除术后胃瘫综合征的主要病理变化是残胃无力、排空障碍伴扩张或黏膜水肿。其原因可能与手术损伤残胃(包括肌层)的迷走神经或血液淋巴循环有关。术前有幽门梗阻者易发生胃瘫综合征。

Gastroparesis syndrome after radical distal distogastrectomy for gastric cancer

Objective:To investigate the cause of gastroparesis syndrome after radical distal gastrectomy for gastric cancer.Methods:From January 1990 to December 2005 the clinical data of 456 patients underwent radical distogastrectomy for gastric cancer were analyzed retrospectively.Results:Postoperative gastroparesis syndrome occurred in 9 of 456 patients underwent radical surgery on distal stomach,the rate of gastroparesis occurrence was not different between with and without anemia or hypoproteinemia(P>0.05),but the rate of postoperative gastroparesis syndrome occurred in patients with pyloric obstruction was significantly higher than without pyloric obstruction.Radiography and gastroscopy were performed for the 9 patients.Gastric emptying delay and absent peristalsis were detected in all 9 patients;Serious swelling of gastric remnant mucosa and the gastro-intestinal anastomosis stoma covered by the swelling mucosa in 6 patients(66.67%,6/9);Dilatation and atony of gastric remnant,the anastomosis not covered in 3 patients(33.33%,3/9).Conclusion:The basic pathology changes of gastroparesis syndrome after distal gastrectomy were atony,emptying delay,dilatation or serious mucosa swelling of the gastric remnant.The cause may be related to injury of the vagus nerves,the blood and lymphatic vessels of the gastric remnant.The postoperative gastroparesis syndrome is easy to occur in patients with preoperative pyloric obstruction.