【摘要】：目的:本次研究回顧性分析了皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院2014年至2016年收治的229例行遠(yuǎn)端胃癌根治術(shù)的患者病例,旨在分析發(fā)生術(shù)后胃癱綜合征的高危因素,為臨床的防治工作提供參考,降低術(shù)后胃癱綜合征的發(fā)生率。方法:搜集皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院2014年6月至2016年6月胃腸外科病區(qū)收治的229例行遠(yuǎn)端胃癌根治術(shù)的患者資料,其中發(fā)生術(shù)后胃癱綜合征的患者共19例,其中男性患者為13人,女性患者為6人,男:女=13:6;患者年齡39-79歲,平均年齡61.68歲,將患者分為胃癱組與非胃癱組,選取一般情況,術(shù)前,術(shù)中及術(shù)后共19項(xiàng)危險(xiǎn)因素進(jìn)行單因素χ2檢驗(yàn),將圍手術(shù)期有顯著差異的單因素行多因素Logistic回歸分析。結(jié)果:本次研究總體病例數(shù)為229例,PGS發(fā)生率:8.29%(19/229)。通過(guò)單因素χ2檢驗(yàn)結(jié)果可得;肥胖,術(shù)前營(yíng)養(yǎng)不良,術(shù)前幽口梗阻、圍手術(shù)期低蛋白血癥(血清白蛋白30g/l)、圍手術(shù)期高血糖(空腹血糖8mmol/l)、消化道吻合方式(Billroth I式與Billroth II式),術(shù)后腹腔并發(fā)癥,焦慮等因素具有統(tǒng)計(jì)學(xué)意義(P0.05),為PGS的相關(guān)因素;而患者的性別、年齡、高血壓史、術(shù)前貧血、術(shù)前是否行新輔助化療、術(shù)中是否行腹腔灌注治療、手術(shù)方式(腹腔鏡手術(shù)或傳統(tǒng)開腹手術(shù))、手術(shù)時(shí)間(是否3.5h)、手術(shù)出血量(是否400ml)、術(shù)后病理分期、術(shù)后是否使用鎮(zhèn)痛泵等因素?zé)o統(tǒng)計(jì)學(xué)意義(P0.05),多因素Logistic回歸分析顯示,術(shù)前幽口梗阻、圍手術(shù)手術(shù)期低蛋白(ALB30g/l),圍手術(shù)期高血糖(空腹血糖8mmol/l)、焦慮為PGS的危險(xiǎn)因素(OR1,P0.05),Billroth I式吻合方式為PGS的保護(hù)因素(OR1,P0.05)。結(jié)論:PGS是由多因素造成的,單因素χ2檢驗(yàn)表明肥胖、術(shù)前營(yíng)養(yǎng)不良,術(shù)前幽門梗阻,圍手術(shù)期高血糖,圍手術(shù)期低蛋白,消化道吻合方式,術(shù)后并發(fā)癥、術(shù)后焦慮等都與PGS的發(fā)生相關(guān)。多因素Logistic分析結(jié)果表明,存在術(shù)前消化道梗阻,圍手術(shù)期低蛋白,圍手術(shù)期高血糖,術(shù)后焦慮等4個(gè)因素為術(shù)后胃癱綜合征的危險(xiǎn)因素,BillrothⅠ式消化道吻合方式為術(shù)后胃癱綜合征的保護(hù)因素。臨床工作中,醫(yī)務(wù)工作者應(yīng)考慮到PGS的相關(guān)危險(xiǎn)因素,積極做好危險(xiǎn)因素的處理工作,從而做到術(shù)后胃癱綜合征的有效規(guī)避,提高手術(shù)治療效果,減少患者術(shù)后不必要的痛苦,為PGS的預(yù)防與治療提供更有效的保障。
[Abstract]:Objective: to analyze the risk factors of postoperative gastroparesis syndrome (GPS) in 229 patients with distal gastric cancer treated in Yaji Mountain Hospital of Southern Anhui Medical College from 2014 to 2016. To provide reference for clinical prevention and treatment, to reduce the incidence of postoperative gastroparesis syndrome. Methods: data of 229 patients undergoing radical gastrectomy of distal gastric cancer were collected from June 2014 to June 2016 in Gastrointestinal surgery Hospital affiliated to Southern Anhui Medical College. Among them, 19 patients suffered from postoperative gastroparesis syndrome. There were 13 male patients and 6 female patients, male: female = 13: 6; The patients aged 39-79 years with an average age of 61.68 years were divided into two groups: gastroparesis group and non-gastroparesis group. A total of 19 risk factors were tested by 蠂 2 test before, during and after operation. Multivariate Logistic regression analysis was performed on the single factor with significant difference in perioperative period. Results: the total number of cases in this study was 229. The incidence of PGS was 8.29% (19 / 229). The results were obtained by single factor 蠂 2 test. Obesity, preoperative malnutrition, preoperative mouth obstruction, perioperative hypoproteinemia (30g/l), perioperative hyperglycemia (8mmol/l), digestive tract anastomosis (Billroth I and Billroth II), Postoperative abdominal complications, anxiety and other factors have statistical significance (P0.05), which is the related factor of PGS; Sex, age, history of hypertension, preoperative anemia, preoperative neoadjuvant chemotherapy, intraoperative intraperitoneal perfusion, operative methods (laparoscopic or traditional open surgery), operative time (3.5 hours), There was no significant difference in blood loss (400ml), postoperative pathological stage, postoperative analgesia pump and so on (P0.05). Multivariate Logistic regression analysis showed that preoperative mouth obstruction, perioperative low protein (ALB30g/l), and so on. Perioperative hyperglycemia (8mmol/l) and anxiety were risk factors of PGS (OR1,P0.05), Billroth I anastomosis was the protective factor of PGS (OR1,P0.05). Conclusion: PGS is caused by multiple factors. Univariate 蠂 2 test shows that obesity, preoperative malnutrition, preoperative pyloric obstruction, perioperative hyperglycemia, perioperative low protein, anastomosis of digestive tract, postoperative complications. Postoperative anxiety was associated with PGS. Multivariate Logistic analysis showed that there were four risk factors of postoperative gastroparesis syndrome, including preoperative digestive tract obstruction, perioperative low protein, perioperative hyperglycemia and postoperative anxiety. Billroth 鈪，

本文編號(hào)：2325825