根治性遠端胃大部切除術(shù)后胃癱綜合征的危險因素分析及治療措施
發(fā)布時間：2019-06-29 10:45
【摘要】：目的:PGS特指手術(shù)后并發(fā)的以胃運動功能不佳為主的一種臨床綜合征,常發(fā)生在腹部手術(shù)后,其中單純胃術(shù)后患者中有10%~25%曾經(jīng)發(fā)生過胃排空延滯,在其當中有5%~10%的病人發(fā)生過有感的臨床表現(xiàn)。常因胃術(shù)后非機械性梗阻的流出道因素引起,故又被稱為術(shù)后功能性胃癱,是一種胃部手術(shù)后臨床上常見的并發(fā)癥。它會導(dǎo)致患者術(shù)后出現(xiàn)營養(yǎng)吸收障礙,以致恢復(fù)時間延長,醫(yī)療費用明顯增加,對患者的心理產(chǎn)生不利影響,并有可能誘發(fā)其他并發(fā)癥,甚至危及到患者的生命。胃癱在臨床上極易被診斷為機械性胃流出通道梗阻,若盲目采用手術(shù)治療方式,極易產(chǎn)生病情的加重甚至延誤最佳治療時機。本文旨在通過收集我院胃腸外科一區(qū)行根治性遠端胃大部切除術(shù)患者的臨床資料,分析導(dǎo)致胃排空障礙的相關(guān)危險因素及總結(jié)治療措施,為今后臨床工作提供借鑒。方法:收集2010年1月至2014年12月就診于福建醫(yī)科大學(xué)附屬第一醫(yī)院胃腸一區(qū)行根治性遠端胃大部切除術(shù)的病人的病案資料,采用回顧性分析方法,將21例發(fā)生PGS病人當做病例組,389例未發(fā)生PGS病人當做研究對照組。應(yīng)用SPSS19.0軟件先進行單因素χ2檢驗分析是否有統(tǒng)計學(xué)意義,后以是否發(fā)生PGS為應(yīng)變量,可能影響PGS發(fā)生的13個因素為自變量進行賦值,應(yīng)用非條件多元素Logistic回歸模型進行,研究其對PGS的發(fā)生所產(chǎn)生的影響。結(jié)果:本研究經(jīng)單因素χ2檢驗表明胃腸吻合方式、術(shù)前存在幽門梗阻、術(shù)前營養(yǎng)不良、術(shù)后開始腸內(nèi)營養(yǎng)時間、術(shù)后腹腔并發(fā)癥有統(tǒng)計學(xué)意義(P0.05);經(jīng)多因素Logistic回歸分析結(jié)果表明:Billroth II式、術(shù)前幽門梗阻、術(shù)后開始腸內(nèi)營養(yǎng)時間、術(shù)前營養(yǎng)不良、術(shù)后腹腔并發(fā)癥是PGS發(fā)生的危險因素(OR1,P0.05)。結(jié)論:根治性遠端胃大部切除術(shù)后PGS的發(fā)生與多種因素有關(guān),Billroth II式、術(shù)前存在幽門梗阻、術(shù)后開始腸內(nèi)營養(yǎng)時間、術(shù)前營養(yǎng)不良、術(shù)后腹腔并發(fā)癥可能是術(shù)后胃癱發(fā)生的危險因素,其中術(shù)后腹腔并發(fā)癥是發(fā)生PGS的高危因素。積極處置上述高危因素可降低發(fā)生PGS的概率。胃癱病人盡可能的采用保守治療措施。
[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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R656.6
本文編號：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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R656.6
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，本文編號：2507754
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