摘要
目的 探讨胰十二指肠切除术（PD）术后胃排空延迟（DGE）发生的危险因素和治疗.方法 回顾性分析2009 年1 月至2013 年5 月在西安交通大学第一附属医院行PD 术的395 例中术后发生DGE 的45 例患者临床资料.其中男21 例,女24 例;平均年龄（58±2）岁.所有患者均签署知情同意书,符合医学伦理学规定.所有患者术后常规监护并预防性使用抗生素24～48 h,患者夹闭胃管和通气后可进食少量流质,如无腹胀、腹痛等不适逐渐过渡至软食或正常饮食.观察患者术后并发症发生情况.PD 术后DGE 发生的危险因素分析采用Logistic 回归分析.结果 395 例接受PD 术患者中,45 例术后发生DGE,发生率11.4%.胆漏、胰瘘、腹腔脓肿是PD 术后DGE 发生的独立危险因素（OR=9.9,2.5,4.2;P〈0.05）.采用促胃肠动力药（红霉素、甲氧氯普胺、多潘立酮）治疗有效率为53%（24/45）.剩余21 例药物治疗无效患者中14 例接受针灸治疗,治疗有效率86%（12/14）.结论 胆漏、胰瘘、腹腔脓肿是PD 术后DGE 发生的独立危险因素. DGE 是一种多病因疾病,综合应用促胃肠动力药、针灸等治疗可改善部分患者症状.
ObjectiveTo investigate the risk factors and treatments for delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).MethodsClinical data of 45 patients developing DGE out of 395 patients undergoing PD in the First Afifliated Hospital of Xi'an Jiaotong University between January 2009 and May 2013 were retrospectively studied. Among the 45 patients, 21 were males and 24 were females with the average age of (58±2) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. All patients were given routine postoperative monitoring and preventive antibiotics for 24-48 h. After nasogastric tube clipping and ventilation, patients were fed with a small amount of fluids, then gradually back on soft diet or normal diet in case of no abdominal distention and abdominal pain. The incidence of postoperative complications was observed.The risk factors for DGE after PD was analyzed using Logistic regression analysis.ResultsAmong the 395 patients undergoing PD, 45 developed DGE after PD with the incidence of 11.4%. Bile leakage, pancreatic fistula and intra-abdominal abscess were independent risk factors for DGE after PD (OR=9.9, 2.5, 4.2;P<0.05). The effective rate of treatment with prokinetic agents (erythromycin, metoclopramide and domperidone) was 53% (24/45). The other 21 patients who did not respond to the prokinetic agents received acupuncture therapy with the effective rate of 86% (12/14).ConclusionsBile leakage, pancreatic fistula and intra-abdominal abscess are independent risk factors for DGE after PD. DGE is a disease with multiple etiological factors. Symptoms of some patients can be improved by prokinetic agents and acupuncture therapy.
出处
《中华肝脏外科手术学电子杂志》
CAS
2015年第6期335-339,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
国家自然科学基金(81372582)
陕西省青年科技新星支持项目(2014KJXX-30)
关键词
胰十二指肠切除术
胃排空
危险因素
治疗学
Pancreaticoduodenectomy
Gastric Emptying
Risk factors
Therapeutics
