胃癌术后胃瘫综合征的原因分析与诊治

发布时间：2017-12-27 09:02

本文关键词：胃癌术后胃瘫综合征的原因分析与诊治　出处：《山东大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景与目的：临床上行腹部手术尤其是胃肠道和胰腺手术后发生的术后胃瘫综合征(postsurgical gastroparesis syndrome, PGS),也是临床上行胃癌根治性手术后常见并发症之一,通过回顾分析山东大学齐鲁医院胃肠外科近5年来行远端胃癌根治术后发生胃瘫综合征病人的临床资料,总结分析导致胃癌术后胃瘫的相关因素,探讨其诊断、治疗及预防措施。方法：回顾性分析2010.07-2015.07期间因胃癌收治于山东大学齐鲁医院胃肠外科行远端胃癌根治术的患者1350例,术后发生胃瘫患者46例,胃瘫发生率为3.41%(46/1350)；其中男性患者25例,女性患者21例,男：女=1.2：1；患者年龄25-80岁,平均年龄61.02岁。参考相关文献研究及结合临床经验,选取可能影响PGS的14个相关因素：性别、年龄、术前贫血、幽门梗阻、术前新辅助化疗、围手术期低蛋白血症、手术方式(腹腔镜手术或传统开腹手术)、消化道重建方式(Billroth Ⅰ式或Billroth Ⅱ式)、术中出血量、手术时间、术后肠内营养开始时间、术后高血糖、术后自控镇痛泵的使用、术后腹腔并发症,根据这些相关因素将病人分为胃瘫综合征组(PGS组)和对照组(非PGS组)。应用IBMSPSS 21.0软件先进行单因素χ2检验,找出其中可能的危险因素,分析是否有统计学意义,然后应用Logistic Regression进行多因素分析,研究这些危险因素对PGS的发生所产生的影响。结果：通过回顾性分析46例PGS组患者临床资料,PGS发生率为3.41%(46/1350)；发病时间在术后7d-15d,所有PGS患者经保守治疗后均顺利恢复,无二次手术病例,其中经保守治疗后34例患者(74%)在术后6周左右恢复,11例患者(24%)在术后8周左右恢复,1例患者(2%)经保守治疗在第11周恢复；本次研究单因素分析表明,术前贫血、幽门梗阻、围手术期低蛋白(ALB30g/L)、消化道重建方式、术后高血糖(血糖≥8mmol/L)、术后腹腔并发症6个因素与PGS的发生有关(P0.05),非条件多因素Logistic回归分析显示,术前贫血、幽门梗阻、围手术期低蛋白(ALB30g/L)、Billroth Ⅱ式吻合、术后高血糖(血糖8mmol/L)、术后腹腔并发症为PGS的危险因素(OR1,P0.05),而血清白蛋白大于30g/L是术后PGS的保护因素(OR1,P0.05)。结论：口前对于胃癌根治术后胃瘫综合征(PGS)诱因的研究较多,但其确切原因尚不明确,多种因素共同作用是引起PGS的原因,单因素分析表明,术前贫血、幽门梗阻、围手术期低蛋白(ALB30g/L)、消化道重建方式、术后高血糖(血糖8mmol/L、术后腹腔并发症6个因素与PGS的发生有关,Logistic回归分析显示,术前贫血、幽门梗阻、围手术期低蛋白(ALB30g/L)、Billroth Ⅱ式吻合、术后高血糖(血糖≥8mmol/L)、术后腹腔并发症为PGS的危险因素,而血清白蛋白大于30g/L是术后预防PGS发生的保护因素。针对这些危险因素,在术前、手术中及术后采取相关措施,积极预防和治疗PGS的发生,对于降低PGS的发病率及对缩短PGS患者术后的恢复时间具有重要意义。目前对PGS的治疗主要以保守治疗为主,肠内营养、促胃动力药的应用及中医针灸治疗等对于PGS患者具有良好的疗效,在除外机械性梗阻的前提下,避免再次手术,心理安慰在PGS患者的治疗中也发挥了重要的作用。
[Abstract]:Background and objective: the clinical significance of abdominal surgery especially gastroparesis syndrome occurred in the gastrointestinal tract and pancreas surgery after surgery (postsurgical gastroparesis, syndrome, PGS) is one of the common complications of gastric cancer clinically after radical surgery, the clinical data were retrospectively analyzed by gastrointestinal surgery, Qilu Hospital of Shandong University for nearly 5 years after distal gastrectomy for gastric cancer gastroparesis syndrome patients, summarize and analyze the factors related to gastroparesis after radical resection of gastric carcinoma, and to investigate its diagnosis, treatment and preventive measures. Methods: a retrospective analysis of 2010.07-2015.07 during gastric cancer treated in the Qilu Hospital of Shandong University of gastrointestinal surgery, radical resection of distal gastric cancer patients 1350 cases of gastroparesis in 46 patients with postoperative gastroparesis was 3.41% (46/1350); 25 cases of male patients, female patients with 21 cases, male: female =1.2:1 patients aged 25-80 years; the average age of 61.02 years. Refer to the relevant literature research and clinical experience, selection may affect 14 PGS related factors: gender, age, preoperative anemia, pyloric obstruction, neoadjuvant chemotherapy, surgical perioperative period, hypoalbuminemia (laparoscopic or laparotomy), digestive tract reconstruction (Billroth 1 type or Billroth type), intraoperative bleeding volume, operation time, postoperative enteral nutrition start time, postoperative hyperglycemia, postoperative analgesia pump use, postoperative abdominal complications, according to the related factors of the patients were divided into gastroparesis syndrome group (PGS group) and control group (non PGS group). IBMSPSS 21 software was used to conduct single factor 2 test to identify possible risk factors and analyze whether there was statistical significance. Then Logistic Regression was used to conduct multivariate analysis to study the impact of these risk factors on the occurrence of PGS. Results: through retrospective analysis of 46 cases of PGS patients clinical data, the incidence rate of PGS was 3.41% (46/1350); onset time in 7d-15d after surgery, all PGS patients after conservative treatment were successfully restored, no two cases, including 34 cases with conservative treatment patients (74%) recovered in 6 weeks after operation about 11 patients (24%) recovered in 8 weeks after operation, 1 patients (2%) recovered after conservative treatment in eleventh weeks; the single factor analysis showed that preoperative anemia, pyloric obstruction, perioperative low protein (ALB30g/L), digestive tract reconstruction, postoperative hyperglycemia (blood glucose over 8mmol/L) and postoperative abdominal complications 6 factors related with PGS (P0.05), non conditional multivariate Logistic regression analysis showed that preoperative anemia, pyloric obstruction, perioperative low protein (ALB30g/L) and Billroth II anastomosis, postoperative high blood sugar (glucose 8mmol/L), intraperitoneal and The risk factor of PGS (OR1, P0.05) is the risk factor for the onset of the disease (P0.05), and the serum albumin greater than 30g/L is the protective factor of PGS after operation (OR1, P0.05). Conclusion: before the mouth for gastroparesis syndrome after radical resection of gastric cancer (PGS) study more incentives, but the exact cause is not clear, many factors are the cause of PGS, univariate analysis showed that preoperative anemia, pyloric obstruction, perioperative low protein (ALB30g/L), digestive tract reconstruction after surgery, high blood sugar (glucose 8mmol/L, postoperative abdominal complications 6 factors related with PGS, Logistic regression analysis showed that preoperative anemia, pyloric obstruction, perioperative low protein (ALB30g/L) and Billroth II anastomosis, postoperative hyperglycemia (glucose or 8mmol/L), postoperative abdominal complications for PGS the risk factors, while serum albumin is greater than 30g/L to prevent the protective factors of PGS after surgery. In view of these risk factors, taking relevant measures before, during and after operation to prevent and treat the occurrence of PGS is of great significance for reducing the incidence of PGS and shortening the recovery time of PGS patients. The treatment of PGS is mainly based on conservative therapy, prokinetic drugs, enteral nutrition and application of acupuncture and moxibustion therapy has good curative effect for patients with PGS, except in the premise of mechanical obstruction, avoid reoperation, psychological comfort in the treatment of patients with PGS has also played an important role.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.2;R573

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