食管癌术后胸胃排空障碍临床分析
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摘要
目的探讨食管癌术后胸胃排空障碍的相关因素、临床特点,为临床治疗及预防提供相应的理论依据。
方法回顾性分析了福建医科大学附属协和医院胸外科及肿瘤科从1996年02月至2010年02月行食管癌切除+胃代食管消化道重建术的临床病例资料(n=973)分为A、B两组,前者为术后并发胸胃排空障碍患者,后者术后无并发胸胃排空障碍。
结果食管癌术后胸胃排空障碍符合入选标准的共有31例,占同期食管癌手术1682例的1.84%。其中颈、胸、腹三切口食管癌切除食管-胃颈部吻合23例,右胸、上腹二切口食管癌切除食管-胃右胸顶吻合5例,左开胸食管癌切除食管-胃左弓下吻合2例,其他手术方式食管癌切除食管-胃左颈部吻合1例。患者出现症状时间为术后4-36d,(平均12±2.4d)。所有患者均给予胃肠减压、营养支持、高渗盐水洗胃、维持水、电解质代谢平衡及应用促胃动力药物等治疗,6例患者给予心理干预,2例行经皮内镜下胃／空肠造口术治疗。31例胸胃排空障碍病人中29例经保守治疗痊愈,2例术后一月自动出院,无死亡病例；所有患者均于发病后14-73 d,(平均26±4.3d)后恢复胃功能。
结论1.胃排空障碍多见于高位食管胃吻合术后,以食管胃颈部吻合者多见。
2.手术方式、吻合位置以及是否患有慢性胃炎,与术后胸胃排空障碍发生有明显关系。
3迷走神经切断及胃解剖位置的变化是胃排空障碍的重要原因。
Objective To examine the relationship between the related factors and clinical features of delayed gastric emptying in postoperative patients with esophagectomy resection and provide theoretical basis for the clinical therapy and prophylaxis.
Methods The data of patients with gastric esophageal tract reconstruction due to esophagectomy resection in the Union Hospital of Fujian Medical University from 1996 to 2010 were investigated retrospectively (n=973). Two groups were identified:those with known pre-existing delayed gastric emptying (Group A) and those without (Group B).
Results The incidence of delayed gastric emptying after esophagectomy in 1682 patients with esophageal cancer was 1.84%. Of thirty-one patients with delayed gastric emptying; twenty-four had esophagectomy with cervical anastomosis; seven had intrathoracic anastomosis. The symptoms occurred in 4 to 36 days(average:12±2.4 days) after operation. The management included gastrointestinal decompression、nutritional support、gastric lavage、maintenance of hydroelectrolytic balance and application of prokinetic drugs. six cases accorded psychological intervention; two cases afforded pereutaneous endoscopic gastrostomy or jejunostomy. Of thirty-one cases of thoracic delayed gastric emptying in 29 patients cured by conservative treatment, two cases Self-discharge in one month after surgery and no deaths。After onset in all patients at 14-73 d, (average 26±4.3d) recovery of gastric function.
Conclusions
1. FDGE are more common in patients with high esophagogastric anastomosis and often developed in patients with esophagogastric cervical anastomosis.
2. The occurrence of FDGE have distinct connections with chronic gastritis; the method of surgical and the location of the anastomosis.
3. Vagotomy and anatomic changes in the stomach are the main causes of FDGE.
方法回顾性分析了福建医科大学附属协和医院胸外科及肿瘤科从1996年02月至2010年02月行食管癌切除+胃代食管消化道重建术的临床病例资料(n=973)分为A、B两组,前者为术后并发胸胃排空障碍患者,后者术后无并发胸胃排空障碍。
结果食管癌术后胸胃排空障碍符合入选标准的共有31例,占同期食管癌手术1682例的1.84%。其中颈、胸、腹三切口食管癌切除食管-胃颈部吻合23例,右胸、上腹二切口食管癌切除食管-胃右胸顶吻合5例,左开胸食管癌切除食管-胃左弓下吻合2例,其他手术方式食管癌切除食管-胃左颈部吻合1例。患者出现症状时间为术后4-36d,(平均12±2.4d)。所有患者均给予胃肠减压、营养支持、高渗盐水洗胃、维持水、电解质代谢平衡及应用促胃动力药物等治疗,6例患者给予心理干预,2例行经皮内镜下胃／空肠造口术治疗。31例胸胃排空障碍病人中29例经保守治疗痊愈,2例术后一月自动出院,无死亡病例；所有患者均于发病后14-73 d,(平均26±4.3d)后恢复胃功能。
结论1.胃排空障碍多见于高位食管胃吻合术后,以食管胃颈部吻合者多见。
2.手术方式、吻合位置以及是否患有慢性胃炎,与术后胸胃排空障碍发生有明显关系。
3迷走神经切断及胃解剖位置的变化是胃排空障碍的重要原因。
Objective To examine the relationship between the related factors and clinical features of delayed gastric emptying in postoperative patients with esophagectomy resection and provide theoretical basis for the clinical therapy and prophylaxis.
Methods The data of patients with gastric esophageal tract reconstruction due to esophagectomy resection in the Union Hospital of Fujian Medical University from 1996 to 2010 were investigated retrospectively (n=973). Two groups were identified:those with known pre-existing delayed gastric emptying (Group A) and those without (Group B).
Results The incidence of delayed gastric emptying after esophagectomy in 1682 patients with esophageal cancer was 1.84%. Of thirty-one patients with delayed gastric emptying; twenty-four had esophagectomy with cervical anastomosis; seven had intrathoracic anastomosis. The symptoms occurred in 4 to 36 days(average:12±2.4 days) after operation. The management included gastrointestinal decompression、nutritional support、gastric lavage、maintenance of hydroelectrolytic balance and application of prokinetic drugs. six cases accorded psychological intervention; two cases afforded pereutaneous endoscopic gastrostomy or jejunostomy. Of thirty-one cases of thoracic delayed gastric emptying in 29 patients cured by conservative treatment, two cases Self-discharge in one month after surgery and no deaths。After onset in all patients at 14-73 d, (average 26±4.3d) recovery of gastric function.
Conclusions
1. FDGE are more common in patients with high esophagogastric anastomosis and often developed in patients with esophagogastric cervical anastomosis.
2. The occurrence of FDGE have distinct connections with chronic gastritis; the method of surgical and the location of the anastomosis.
3. Vagotomy and anatomic changes in the stomach are the main causes of FDGE.
引文
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[18]Jorba R, Fabregat J, Borobia FG, et al. Small bowel necrosis in assciation with early postoperative enteral feeding after pancreatic resection [J]. Surgery,2000,128:111-112.
[19]Kenneth A. Kudsk,M.D, Current aspects of mucosal immunology and its Influence by nutriation [J]. The American Journal of Surgery,2002,183:390-398.
[20]Hasse Abrahamsson. Treatment options for patients with severe gastroparesis [J]. Gut, 2007,56(6):877-883.
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[2]Araki K, Ohno S, Egashira A, et al. Pathologic features of superficial esphageal squamous cell carcinoma with lymphnode and distal metastasis [J]. Cancer,2002,94(2): 570-575
[3]吴蔚,熊刚,杨康.食管癌贲门癌术后胸胃排空障碍的临床分析[J].消化外科,2005；4(3)：2454.
[4]王永岗,张汝刚,张大为.27例食管癌切除术后胃排空障碍[J].中华胸心血管外科杂志,1998,14(4)：224-226.
[5]Finley FJ, Lamy A, Clifton J, et al, Gastrointestinal function following esophagectomy for malignancy.[J].Am J Surg,1995,169(5):471-475
[6]Urschel JD, Blewett CJ, Young JE, et al,Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy:a meta—analysis of randomized controlled trials.[J]. Dig Surg,2002,19(3):160-164
[7]Jamesom F, Ivan D, Zhiyue L, et al. Absence of the intestinal cells of cajal in patients with gastroparesis and correlation with clinical findings[J]. Gastreenterel Surg,2005,9(1): 102-108.
[8]王志刚,刘凤林.胃瘫治疗的进展[J].国外医学.消化系疾病分册,2002,22(1)：8-11.
[9]Michael Lanuti, Pierre E. de Delva,Cameron D. Wright, et al. Post-esophagectomy gastric outlet obstruction:role of pyloromyotomy and management with endoscopic pyloric dilatation [J]. Eur J Cardiothorac Surg,2007,31:149-153.
[10]王其彰,张长保,李保庆,等.食管癌切除术后双相胃排空[J].中华胸心血管外科杂志,1999,15(6)：335-336.
[11]赵云平,王如文,蒋耀光等.食管胃吻合术后胃排空障碍探讨[J].消化外科杂志,2004,3(1)：43.
[12]李国仁,戴建华.食管癌贲门癌切除术后胃食管反流研究的国内文献荟萃[J].中华胸心血管外科杂志,2006,22：143-144.
[13]Kallfa JC, Schraut WH, Biuiar TR, etal. Role of inducible intrieoxide synthase in postoperative in testinal smooth muscle dysfunction in rodents[J], Gastro enterology,2000, 118(11):316-317.
[14]Lee HS, Kim MS, Lee JM, et al. Intrathoracic gastric emptying of solid food after esophagectomy for esophageal cancer[J]. Ann Thorac Surg,2005,80(2):443-447.
[15]王涛,高文,朱余明,等.食管癌术后胃瘫的诊断和治疗体会(附9例报告)[J].中国癌症杂志,2004,14(3)：295-296.
[16]秦新裕,刘凤林.术后肠胃动力紊乱的研究进展[J].中华胃肠外科杂志,2005,8(3)：193-195.
[17]王大力,张汝刚,孙克林,等.保留或切断迷走神经干的食管癌切除术后胃消化功能的对比研究[J].中华肿瘤杂志2000；22(5)：414-416
[18]吴仕光,万桂玲,葛来增,等,食管癌患者胃黏膜病变与术后胃排空延迟[J].世界华人消化杂志,2005,13(1)141-142
[19]王其彰,王如然,马立敏,等.显示子用于检查食管癌切除术后胃排空[J].中华外科杂志2000；38：529-530.
[20]Ishiguchi T, Tada H, Nakagawa K, et al. Hyperglycemia impairs antropyloric coordination and delays gastriv emptying in conscious rats [J], Aution Neurosci,2002,95 (1-2):112.
[21]Hasler. WL. Gastroparesis-Current Concepts and Considerations [J] Medscape J Med, 2008,10(1):16.
[22]Widar Smith CH, HILLL, Wilkins J, et al, Effects of morphine and tramadol on sonmalic and visceral senaory function and gastrointestional Moutility after abdominal surgery [J]. Anesthesiology,1999,9(3):639.
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