• 西安醫(yī)學(xué)院第二附屬醫(yī)院普外科（西安，710038）;

【摘要】　目的　 探討腹部非胃、十二指腸手術(shù)后胃癱綜合征（postoperative gastroparesis syndrome，PGS）發(fā)生的高危因素。　方法　 回顧分析2004年9月-2010年3月2 559例腹部非胃、十二指腸術(shù)后患者的臨床資料，將患者分為PGS組和非PGS組，其中PGS組23例，非PGS組2 536例。　結(jié)果　 比較PGS組和非PGS組間年齡、性別、術(shù)后開(kāi)始進(jìn)食時(shí)間、手術(shù)持續(xù)時(shí)間、是否為腫瘤晚期、有無(wú)貧血低蛋白血癥、既往有無(wú)腹部手術(shù)史、術(shù)后早期有無(wú)營(yíng)養(yǎng)支持等因素，χ2值分別為:19.687、0.018、0.346、48.243、21.801、16.803、24.679、0.870，P值分別是: lt;0.01、 gt;0.05、 gt;0.05、 lt;0.01、 lt;0.01、 lt;0.01、 lt;0.01、 gt;0.05。　結(jié)論　 年齡 gt;65歲、手術(shù)持續(xù)時(shí)間 gt;4 h、腫瘤晚期、既往有腹部手術(shù)史及貧血低蛋白血癥是腹部非胃、十二指腸手術(shù)后PGS發(fā)生的高危因素。
【Abstract】　Objective　 To analyze the risk factors of postoperative gastroparesis syndrome (PGS) after non-gastroduodenal abdominal surgery. 　Methods　 We retrospectively analyzed the clinical data of 2 559 patients who underwent non-gastroduodenal abdominal surgeries in our hospital between September 2004 and March 2010. We divided them into the PGS group with 23 patients and the non-PGS group with 2 536 patients.　Results　 By comparing the age, the gender, the starting time of eating after surgery, the duration of surgery, whether the patients had advanced cancer, whether anemia or hypoproteinemia existed, whether the patients had a history of previous abdominal surgery, and whether nutritional support was provided early after operation between the PGS group and the non-PGS group, we found that the chi-square value was 19.687, 0.018, 0.346, 48.243, 21.801, 16.803, 24.679, 0.870 and the P value was lt;0.01,  gt;0.05,  gt;0.05,  lt;0.01,  lt;0.01,  lt;0.01,  lt;0.01,  gt;0.05 respectively.　Conclusion　 Over 65 years of age, the duration of surgery over four hours, advanced cancer, the history of previous abdominal surgery and anemia or hypoproteinemia are the risk factors of PGS after non-gastroduodenal abdominal surgery.

引用本文： 丁思勤,汪振亮,張華洲,王鐸,郭平學(xué),楊自華. 腹部非胃及十二指腸術(shù)后發(fā)生胃癱綜合征的高危因素分析. 華西醫(yī)學(xué), 2011, 26(4): 532-534. doi: 復(fù)制

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2. 　劉鳳林, 秦新裕. 根治性胃大部切除術(shù)后胃癱綜合征的回顧性研究[J]. 中華胃腸外科雜志, 2002, 5(4): 245- 248.
3. 　秦新裕. 胃十二指腸潰瘍外科治療不同術(shù)式與胃腸動(dòng)力的關(guān)系[J]. 中國(guó)實(shí)用外科雜志, 1998, 18(1): 59-60.
4. 　Ali T, Hasan M, Hamadani M, et al. Gastroparesis[J]. South Med J, 2007, 100(3): 281-286.
5. 　Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerations[J]. World J Gastroenterol, 2009, 15(1): 25-37.
6. 　Eisner M. Gastrointestinal effects of metoclopramide in man. In vitro experiments with human smooth muscle preparations[J]. Br Med J, 1968, 4(5632): 679-680.
7. 　Monkovic I, Willner D, Adam MA, et al. Substituted benzamides. 1. Potential non-dopaminergic antagonists of chemotherapy-induced nausea and emesis[J]. J Med Chem, 1988, 31(8): 1548-1558.
8. 　Coulie B, Tack J, Peeters T, et al. Involvement of two different pathways in the motor effects of erythromycin on the gastric antrum in humans[J]. Gut, 1998, 43(3): 395-400.
9. 　崔文軍, 王兵, 崔小兵. 胃癱綜合征的臨床分析[J]. 中國(guó)實(shí)用神經(jīng)疾病雜志, 2009, 12(20): 72.
10. 　Tack J. Gastric motor disorders[J]. Best Pract Res Clin Gastroenterol, 2007, 21(4): 633-644.
11. 　Huizinga JD. Neural injury, repair, and adaptation in the GI tract. IV. Pathophysiology of GI motility related to interstitial cells of Cajal[J]. Am J Physiol, 1998, 275 (3 pt 1): G381-G386.
12. 　Livingston EH, Passaro EP Jr. Postoperative ileus[J]. Dig Dis Sci, 1990, 35(1):121-132.
13. 　黃穎秋. 胃輕癱綜合征的發(fā)病機(jī)制[J]. 世界華人消化雜志, 2001, 9(10): 1162-1168.
14. 　秦新裕, 雷勇. 胃腸肽類激素與胃腸動(dòng)力[J]. 中國(guó)實(shí)用外科雜志, 2001, 21(6): 329-331.
15. 　宋瑞, 陳學(xué)謙, 姜占武. 手術(shù)后胃癱綜合診治進(jìn)展[J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2009, 12(6): 511-513.
16. 　蔡一亭, 秦新裕. 根治性胃大部切除術(shù)后胃癱15例臨床分析[J]. 中國(guó)實(shí)用外科雜志, 1999, 19(6): 338-340.
17. 　秦新裕. 胃大部切除術(shù)后胃腸動(dòng)力紊亂[J]. 中國(guó)實(shí)用外科雜志, 1999, 19(6): 325-326.
18. 　Shafi MA, Pasricha PJ. Post-Surgical and obstructive gastroparesis[J]. Curr Gastroenterol Rep, 2007, 9(4): 280-285.
19. 　Bortolotti M. The “electrical way” to cure gastroparesis[J]. Am J Gastroenterol, 2002, 97(8): 1874-1883.
20. 　Eckhauser FE, Knol JA, Raper SA, et al. Completion gastrectomy for postsurgical gastroparesis syndrome. Preliminary results with 15 patients[J]. Ann Surg, 1988, 208(3): 345-353.
21. 　Masaoka T, Tack J. Gastroparesis: current concepts and management[J]. Gut Liver, 2009, 3(3): 166-173.
  1. 1. 　Parkman HP, Hasler WL, Fisher RS, et al. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis[J]. Gastroenterology, 2004, 127(5): 1592-1622.
  2. 2. 　劉鳳林, 秦新裕. 根治性胃大部切除術(shù)后胃癱綜合征的回顧性研究[J]. 中華胃腸外科雜志, 2002, 5(4): 245- 248.
  3. 3. 　秦新裕. 胃十二指腸潰瘍外科治療不同術(shù)式與胃腸動(dòng)力的關(guān)系[J]. 中國(guó)實(shí)用外科雜志, 1998, 18(1): 59-60.
  4. 4. 　Ali T, Hasan M, Hamadani M, et al. Gastroparesis[J]. South Med J, 2007, 100(3): 281-286.
  5. 5. 　Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerations[J]. World J Gastroenterol, 2009, 15(1): 25-37.
  6. 6. 　Eisner M. Gastrointestinal effects of metoclopramide in man. In vitro experiments with human smooth muscle preparations[J]. Br Med J, 1968, 4(5632): 679-680.
  7. 7. 　Monkovic I, Willner D, Adam MA, et al. Substituted benzamides. 1. Potential non-dopaminergic antagonists of chemotherapy-induced nausea and emesis[J]. J Med Chem, 1988, 31(8): 1548-1558.
  8. 8. 　Coulie B, Tack J, Peeters T, et al. Involvement of two different pathways in the motor effects of erythromycin on the gastric antrum in humans[J]. Gut, 1998, 43(3): 395-400.
  9. 9. 　崔文軍, 王兵, 崔小兵. 胃癱綜合征的臨床分析[J]. 中國(guó)實(shí)用神經(jīng)疾病雜志, 2009, 12(20): 72.
  10. 10. 　Tack J. Gastric motor disorders[J]. Best Pract Res Clin Gastroenterol, 2007, 21(4): 633-644.
  11. 11. 　Huizinga JD. Neural injury, repair, and adaptation in the GI tract. IV. Pathophysiology of GI motility related to interstitial cells of Cajal[J]. Am J Physiol, 1998, 275 (3 pt 1): G381-G386.
  12. 12. 　Livingston EH, Passaro EP Jr. Postoperative ileus[J]. Dig Dis Sci, 1990, 35(1):121-132.
  13. 13. 　黃穎秋. 胃輕癱綜合征的發(fā)病機(jī)制[J]. 世界華人消化雜志, 2001, 9(10): 1162-1168.
  14. 14. 　秦新裕, 雷勇. 胃腸肽類激素與胃腸動(dòng)力[J]. 中國(guó)實(shí)用外科雜志, 2001, 21(6): 329-331.
  15. 15. 　宋瑞, 陳學(xué)謙, 姜占武. 手術(shù)后胃癱綜合診治進(jìn)展[J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2009, 12(6): 511-513.
  16. 16. 　蔡一亭, 秦新裕. 根治性胃大部切除術(shù)后胃癱15例臨床分析[J]. 中國(guó)實(shí)用外科雜志, 1999, 19(6): 338-340.
  17. 17. 　秦新裕. 胃大部切除術(shù)后胃腸動(dòng)力紊亂[J]. 中國(guó)實(shí)用外科雜志, 1999, 19(6): 325-326.
  18. 18. 　Shafi MA, Pasricha PJ. Post-Surgical and obstructive gastroparesis[J]. Curr Gastroenterol Rep, 2007, 9(4): 280-285.
  19. 19. 　Bortolotti M. The “electrical way” to cure gastroparesis[J]. Am J Gastroenterol, 2002, 97(8): 1874-1883.
  20. 20. 　Eckhauser FE, Knol JA, Raper SA, et al. Completion gastrectomy for postsurgical gastroparesis syndrome. Preliminary results with 15 patients[J]. Ann Surg, 1988, 208(3): 345-353.
  21. 21. 　Masaoka T, Tack J. Gastroparesis: current concepts and management[J]. Gut Liver, 2009, 3(3): 166-173.