胃切除术后排空障碍的高危因素与治疗

摘要

Objective　 To investigate risk factors for and management of delayed gastric emptying (DGE) after gastrectomy.　 Method　 A retrospective analysis was made from 482 patients undergoing gastric resection.　 Result　 DGE occurred in 41 of 482 patients (8.5%), risk factors of DGE were diabetes (19%),malnutrition (10%), peritonitis(17%),age(≥60)(14%),gastrointestinal hemorrhage(15%), anastomotic leakage(33%). Subphrenic abscess (39%), pancratobiliary fistula(83%). 　Conclusion　 DGE is paticularly common in patients with diabetes、malnutrition with an age≥60. Postoperative risk factors include peritonitis、gastrointestinal hemorrhage、anastomotic leakage、subphrenic abcess, and pancreatobiliary fistula. Gastric motility resumed in 4 weeks in most patients. Need for reoperation for DGE is rare, total gastrectomy in this case is recommended.%目的探讨胃切除术后排空障碍的高危因素及治疗方法。方法对482例胃切除术病例进行回顾性分析。结果本组482例中有41例出现胃排空障碍，发生率为8.5%。胃切除术后排空障碍的高危因素有糖尿病(19%)、营养不良(10%)、腹膜炎(17%)、高龄（≥60岁）(14%)以及术后消化道出血（15%）、吻合口漏（33%）、膈下感染、脓肿形成（39%）、胆胰漏（83%）等。结论术前及术后存在的高危因素可能是胃切除术后排空障碍的原因。胃动力常在4周内恢复。如需再次手术，以全胃切除为宜。