本文關(guān)鍵詞：胃癌術(shù)后胃癱綜合征的原因分析與診治　出處：《山東大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 遠(yuǎn)端胃癌根治術(shù) 術(shù)后胃癱綜合征 危險因素分析 腸內(nèi)營養(yǎng)

【摘要】：背景與目的：臨床上行腹部手術(shù)尤其是胃腸道和胰腺手術(shù)后發(fā)生的術(shù)后胃癱綜合征(postsurgical gastroparesis syndrome, PGS),也是臨床上行胃癌根治性手術(shù)后常見并發(fā)癥之一,通過回顧分析山東大學(xué)齊魯醫(yī)院胃腸外科近5年來行遠(yuǎn)端胃癌根治術(shù)后發(fā)生胃癱綜合征病人的臨床資料,總結(jié)分析導(dǎo)致胃癌術(shù)后胃癱的相關(guān)因素,探討其診斷、治療及預(yù)防措施。方法：回顧性分析2010.07-2015.07期間因胃癌收治于山東大學(xué)齊魯醫(yī)院胃腸外科行遠(yuǎn)端胃癌根治術(shù)的患者1350例,術(shù)后發(fā)生胃癱患者46例,胃癱發(fā)生率為3.41%(46/1350)；其中男性患者25例,女性患者21例,男：女=1.2：1；患者年齡25-80歲,平均年齡61.02歲。參考相關(guān)文獻(xiàn)研究及結(jié)合臨床經(jīng)驗,選取可能影響PGS的14個相關(guān)因素：性別、年齡、術(shù)前貧血、幽門梗阻、術(shù)前新輔助化療、圍手術(shù)期低蛋白血癥、手術(shù)方式(腹腔鏡手術(shù)或傳統(tǒng)開腹手術(shù))、消化道重建方式(Billroth Ⅰ式或Billroth Ⅱ式)、術(shù)中出血量、手術(shù)時間、術(shù)后腸內(nèi)營養(yǎng)開始時間、術(shù)后高血糖、術(shù)后自控鎮(zhèn)痛泵的使用、術(shù)后腹腔并發(fā)癥,根據(jù)這些相關(guān)因素將病人分為胃癱綜合征組(PGS組)和對照組(非PGS組)。應(yīng)用IBMSPSS 21.0軟件先進(jìn)行單因素χ2檢驗,找出其中可能的危險因素,分析是否有統(tǒng)計學(xué)意義,然后應(yīng)用Logistic Regression進(jìn)行多因素分析,研究這些危險因素對PGS的發(fā)生所產(chǎn)生的影響。結(jié)果：通過回顧性分析46例PGS組患者臨床資料,PGS發(fā)生率為3.41%(46/1350)；發(fā)病時間在術(shù)后7d-15d,所有PGS患者經(jīng)保守治療后均順利恢復(fù),無二次手術(shù)病例,其中經(jīng)保守治療后34例患者(74%)在術(shù)后6周左右恢復(fù),11例患者(24%)在術(shù)后8周左右恢復(fù),1例患者(2%)經(jīng)保守治療在第11周恢復(fù)；本次研究單因素分析表明,術(shù)前貧血、幽門梗阻、圍手術(shù)期低蛋白(ALB30g/L)、消化道重建方式、術(shù)后高血糖(血糖≥8mmol/L)、術(shù)后腹腔并發(fā)癥6個因素與PGS的發(fā)生有關(guān)(P0.05),非條件多因素Logistic回歸分析顯示,術(shù)前貧血、幽門梗阻、圍手術(shù)期低蛋白(ALB30g/L)、Billroth Ⅱ式吻合、術(shù)后高血糖(血糖8mmol/L)、術(shù)后腹腔并發(fā)癥為PGS的危險因素(OR1,P0.05),而血清白蛋白大于30g/L是術(shù)后PGS的保護(hù)因素(OR1,P0.05)。結(jié)論：口前對于胃癌根治術(shù)后胃癱綜合征(PGS)誘因的研究較多,但其確切原因尚不明確,多種因素共同作用是引起PGS的原因,單因素分析表明,術(shù)前貧血、幽門梗阻、圍手術(shù)期低蛋白(ALB30g/L)、消化道重建方式、術(shù)后高血糖(血糖8mmol/L、術(shù)后腹腔并發(fā)癥6個因素與PGS的發(fā)生有關(guān),Logistic回歸分析顯示,術(shù)前貧血、幽門梗阻、圍手術(shù)期低蛋白(ALB30g/L)、Billroth Ⅱ式吻合、術(shù)后高血糖(血糖≥8mmol/L)、術(shù)后腹腔并發(fā)癥為PGS的危險因素,而血清白蛋白大于30g/L是術(shù)后預(yù)防PGS發(fā)生的保護(hù)因素。針對這些危險因素,在術(shù)前、手術(shù)中及術(shù)后采取相關(guān)措施,積極預(yù)防和治療PGS的發(fā)生,對于降低PGS的發(fā)病率及對縮短PGS患者術(shù)后的恢復(fù)時間具有重要意義。目前對PGS的治療主要以保守治療為主,腸內(nèi)營養(yǎng)、促胃動力藥的應(yīng)用及中醫(yī)針灸治療等對于PGS患者具有良好的療效,在除外機(jī)械性梗阻的前提下,避免再次手術(shù),心理安慰在PGS患者的治療中也發(fā)揮了重要的作用。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R735.2;R573

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