Laine M, Sirén J, Koskenpato J, Punkkinen J, Rantanen T, Typpö I, Kokkola A, Sallinen V
1 Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
2 Department of Abdominal Surgery, Porvoo Hospital, Hospital District of Helsinki and Uusimaa, Porvoo, Finland.
Scand J Surg. 2018 Jun;107(2):124-129. doi: 10.1177/1457496917748222. Epub 2017 Dec 21.
Severe, medically uncontrollable gastroparesis is a rare entity, which can be treated using a high-frequency gastric electric stimulator implanted surgically. Previous follow-ups have proven positive outcomes with gastric electric stimulator in patients with gastroparesis. The aim of this study was to evaluate the efficacy and safety of gastric electric stimulator in patients, in whom gastroparesis could not be controlled by conservative means in our country.
This is a retrospective multi-center cohort comprising all patients who had been implanted gastric electric stimulator for severe, medically refractory gastroparesis during 2007-2015 in Finland.
Fourteen patients underwent implantation of gastric electrical stimulator without any postoperative complications. Laparoscopic approach was used in 13 patients (93%). Prior implantation, all patients needed frequent hospitalization for parenteral feeding, 13 had severe nausea, 11 had severe vomiting, 10 had notable weight loss, and 6 had frequent abdominal pain. After operation, none of the patients required parenteral feeding, 11 patients (79%) gained median of 5.1 kg in weight (P < 0.01), and symptoms were relieved markedly in 8 and partially in 3 patients (79%). Of partial responders, two continued to experience occasional vomiting and one mild nausea. Five patients needed medication for gastroparesis after the operation. One patient did not get any relief of symptoms, but gained 6 kg in weight. No major late complications occurred.
Gastric electrical stimulator seems to improve the nutritional status and give clear relief of the symptoms of severe, medically uncontrollable gastroparesis. Given the low number of operations, gastric electrical stimulator seems to be underused in Finland.
严重的、药物难以控制的胃轻瘫是一种罕见病症，可通过手术植入高频胃电刺激器进行治疗。先前的随访已证实胃电刺激器对胃轻瘫患者有积极疗效。本研究的目的是评估胃电刺激器对我国采用保守方法无法控制胃轻瘫的患者的疗效和安全性。
这是一项回顾性多中心队列研究，纳入了2007年至2015年期间在芬兰因严重的、药物难治性胃轻瘫而植入胃电刺激器的所有患者。
14例患者接受了胃电刺激器植入，术后无任何并发症。13例患者（93%）采用了腹腔镜手术方式。植入前，所有患者都需要频繁住院接受肠外营养，13例有严重恶心，11例有严重呕吐，10例有明显体重减轻，6例有频繁腹痛。术后，所有患者均无需肠外营养，11例患者（79%）体重中位数增加了5.1千克（P<0.01），8例患者症状明显缓解，3例部分缓解（79%）。部分缓解的患者中，2例仍偶尔呕吐，1例有轻度恶心。5例患者术后需要药物治疗胃轻瘫。1例患者症状未缓解，但体重增加了6千克。未发生重大晚期并发症。
胃电刺激器似乎能改善营养状况，并明显缓解严重的、药物难以控制的胃轻瘫症状。鉴于手术例数较少，胃电刺激器在芬兰似乎未得到充分应用。
