根治性远端胃大部切除术后胃瘫综合征的危险因素分析及治疗措施
发布时间：2019-06-29 10:45
【摘要】：目的:PGS特指手术后并发的以胃运动功能不佳为主的一种临床综合征,常发生在腹部手术后,其中单纯胃术后患者中有10%~25%曾经发生过胃排空延滞,在其当中有5%~10%的病人发生过有感的临床表现。常因胃术后非机械性梗阻的流出道因素引起,故又被称为术后功能性胃瘫,是一种胃部手术后临床上常见的并发症。它会导致患者术后出现营养吸收障碍,以致恢复时间延长,医疗费用明显增加,对患者的心理产生不利影响,并有可能诱发其他并发症,甚至危及到患者的生命。胃瘫在临床上极易被诊断为机械性胃流出通道梗阻,若盲目采用手术治疗方式,极易产生病情的加重甚至延误最佳治疗时机。本文旨在通过收集我院胃肠外科一区行根治性远端胃大部切除术患者的临床资料,分析导致胃排空障碍的相关危险因素及总结治疗措施,为今后临床工作提供借鉴。方法:收集2010年1月至2014年12月就诊于福建医科大学附属第一医院胃肠一区行根治性远端胃大部切除术的病人的病案资料,采用回顾性分析方法,将21例发生PGS病人当做病例组,389例未发生PGS病人当做研究对照组。应用SPSS19.0软件先进行单因素χ2检验分析是否有统计学意义,后以是否发生PGS为应变量,可能影响PGS发生的13个因素为自变量进行赋值,应用非条件多元素Logistic回归模型进行,研究其对PGS的发生所产生的影响。结果:本研究经单因素χ2检验表明胃肠吻合方式、术前存在幽门梗阻、术前营养不良、术后开始肠内营养时间、术后腹腔并发症有统计学意义(P0.05);经多因素Logistic回归分析结果表明:Billroth II式、术前幽门梗阻、术后开始肠内营养时间、术前营养不良、术后腹腔并发症是PGS发生的危险因素(OR1,P0.05)。结论:根治性远端胃大部切除术后PGS的发生与多种因素有关,Billroth II式、术前存在幽门梗阻、术后开始肠内营养时间、术前营养不良、术后腹腔并发症可能是术后胃瘫发生的危险因素,其中术后腹腔并发症是发生PGS的高危因素。积极处置上述高危因素可降低发生PGS的概率。胃瘫病人尽可能的采用保守治疗措施。
[Abstract]:Objective: PGS refers to a kind of clinical syndrome complicated with poor gastric motility after operation, which often occurs after abdominal surgery. 10% of the patients with simple gastric surgery have had delayed gastric emptying, and 5% of them have had perceptual clinical manifestations. It is often caused by the outflow tract factor of non-mechanical obstruction after gastric operation, so it is also called functional gastroparesis after gastric surgery, which is a common clinical complications after gastric surgery. It will lead to nutritional absorption disorder after operation, so that the recovery time is prolonged, the medical cost is significantly increased, which has a negative impact on the psychology of patients, and may induce other complications, and even endanger the lives of patients. Gastroparesis is easy to be diagnosed as mechanical gastric outflow channel obstruction in clinic. If surgical treatment is blindly adopted, it is easy to aggravate the disease and even delay the best time of treatment. The purpose of this paper was to collect the clinical data of patients undergoing radical distal subtotal gastroresection in one area of gastrointestinal surgery in our hospital, to analyze the risk factors leading to gastric emptying disorder and to summarize the treatment measures, so as to provide reference for clinical work in the future. Methods: from January 2010 to December 2014, the medical records of patients undergoing radical distal subtotal gastroenterectomy in the first affiliated Hospital of Fujian Medical University were collected. 21 patients with PGS were treated as case group and 389 patients without PGS as study control group. SPSS19.0 software was used to analyze whether there was statistical significance by single factor 蠂 2 test, and then the 13 factors that might affect the occurrence of PGS were assigned with the occurrence of PGS as dependent variable. The non-conditional multi-element Logistic regression model was used to study its influence on the occurrence of PGS. Results: univariate 蠂 2 test showed that gastrointestinal anastomosis showed that there were pylorus obstruction before operation, malnutrition before operation, time of enteral nutrition after operation, and postoperative abdominal complications (P 0.05). The results of multivariate Logistic regression analysis showed that: Billroth II type, preoperative pylorus obstruction, postoperative enteral nutrition time, preoperative malnutrition and postoperative abdominal complications were the risk factors of PGS (OR1,P0.05). Conclusion: the occurrence of PGS after radical distal subtotal gastroresection is related to many factors. There are pylorus obstruction before operation, enteral nutrition time after operation, malnutrition before operation, postoperative abdominal complications may be the risk factors of postoperative gastroparesis, and postoperative abdominal complications are the high risk factors for the occurrence of PGS. Actively dealing with the above high risk factors can reduce the probability of PGS. Patients with gastroparesis should be treated as conservatively as possible.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.6
本文编号：2507754
[Abstract]:Objective: PGS refers to a kind of clinical syndrome complicated with poor gastric motility after operation, which often occurs after abdominal surgery. 10% of the patients with simple gastric surgery have had delayed gastric emptying, and 5% of them have had perceptual clinical manifestations. It is often caused by the outflow tract factor of non-mechanical obstruction after gastric operation, so it is also called functional gastroparesis after gastric surgery, which is a common clinical complications after gastric surgery. It will lead to nutritional absorption disorder after operation, so that the recovery time is prolonged, the medical cost is significantly increased, which has a negative impact on the psychology of patients, and may induce other complications, and even endanger the lives of patients. Gastroparesis is easy to be diagnosed as mechanical gastric outflow channel obstruction in clinic. If surgical treatment is blindly adopted, it is easy to aggravate the disease and even delay the best time of treatment. The purpose of this paper was to collect the clinical data of patients undergoing radical distal subtotal gastroresection in one area of gastrointestinal surgery in our hospital, to analyze the risk factors leading to gastric emptying disorder and to summarize the treatment measures, so as to provide reference for clinical work in the future. Methods: from January 2010 to December 2014, the medical records of patients undergoing radical distal subtotal gastroenterectomy in the first affiliated Hospital of Fujian Medical University were collected. 21 patients with PGS were treated as case group and 389 patients without PGS as study control group. SPSS19.0 software was used to analyze whether there was statistical significance by single factor 蠂 2 test, and then the 13 factors that might affect the occurrence of PGS were assigned with the occurrence of PGS as dependent variable. The non-conditional multi-element Logistic regression model was used to study its influence on the occurrence of PGS. Results: univariate 蠂 2 test showed that gastrointestinal anastomosis showed that there were pylorus obstruction before operation, malnutrition before operation, time of enteral nutrition after operation, and postoperative abdominal complications (P 0.05). The results of multivariate Logistic regression analysis showed that: Billroth II type, preoperative pylorus obstruction, postoperative enteral nutrition time, preoperative malnutrition and postoperative abdominal complications were the risk factors of PGS (OR1,P0.05). Conclusion: the occurrence of PGS after radical distal subtotal gastroresection is related to many factors. There are pylorus obstruction before operation, enteral nutrition time after operation, malnutrition before operation, postoperative abdominal complications may be the risk factors of postoperative gastroparesis, and postoperative abdominal complications are the high risk factors for the occurrence of PGS. Actively dealing with the above high risk factors can reduce the probability of PGS. Patients with gastroparesis should be treated as conservatively as possible.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.6
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相关期刊论文 前4条
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