Bar-Natan M, Larson G M, Stephens G, Massey T
Department of Surgery, University of Louisville, Kentucky 40292, USA.
Am J Surg. 1996 Jul;172(1):24-8. doi: 10.1016/S0002-9610(96)00048-7.
The reported incidence of delayed gastric emptying (DGE) after gastric surgery is 5% to 25% and usually is based on operations for peptic ulcer disease. Ongoing improvements in perioperative care, nutritional support, and new prokinetic drugs may have had a beneficial effect on the frequency and course of postoperative DGE.
We therefore studied our recent experience with DGE in 416 patients who had gastric surgery for ulcer disease (283), cancer (92), or trauma and other indications (41) between January 1985 and December 1993. DGE was defined as inability to eat a regular diet by postoperative day 10.
DGE occurred in 99 of 416 patients (24%). In 75 of these 99 patients, a postoperative contributing factor for DGE was identified. These factors were sepsis (32), anastomotic edema and leaks (23), obstruction (4), pancreatitis (3), multiple system organ failure (5), and miscellaneous conditions (8). In 24 patients there was no obvious cause for DGE; these patients recovered with nutritional support and time. Re-operation specifically for gastric stasis was not performed. Among the 99 patients with DGE, 67% were eating by day 21, 92% by 6 weeks, and 100% by 10 weeks. Significant risk factors for DGE were diabetes (55%), malnutrition (44%), and operations for malignancy (38%). The Whipple procedure had the highest incidence of DGE (70%), highly selective vagotomy the lowest (0%), while truncal vagotomy had no significant effect. The response to metoclopramide was 20% and unpredictable.
DGE continues to affect a considerable number of our patients (24%) after gastric surgery and is particularly common in patients with diabetes, malnutrition, and gastric or pancreatic cancer. However, gastric motility does return in 3 to 6 weeks in most patients and the need for re-operation for gastric stasis is rare.
据报道，胃手术后胃排空延迟（DGE）的发生率为5%至25%，通常基于消化性溃疡疾病的手术情况。围手术期护理、营养支持和新型促动力药物的不断改进可能对术后DGE的发生率和病程产生了有益影响。
因此，我们研究了1985年1月至1993年12月期间416例行胃手术的患者中DGE的近期情况，这些患者因溃疡病（283例）、癌症（92例）或创伤及其他适应证（41例）接受胃手术。DGE定义为术后第10天仍无法正常饮食。
416例患者中有99例（24%）发生DGE。在这99例患者中，75例确定了术后导致DGE的因素。这些因素包括败血症（32例）、吻合口水肿和渗漏（23例）、梗阻（4例）、胰腺炎（3例）、多系统器官衰竭（5例）和其他情况（8例）。24例患者DGE无明显原因；这些患者通过营养支持和时间恢复正常。未专门针对胃潴留进行再次手术。在99例DGE患者中，67%在第21天恢复饮食，92%在6周时恢复，100%在10周时恢复正常饮食。DGE的显著危险因素包括糖尿病（55%）、营养不良（44%）和恶性肿瘤手术（38%）。惠普尔手术DGE发生率最高（70%），高选择性迷走神经切断术最低（0%），而迷走神经干切断术无显著影响。甲氧氯普胺的有效率为20%且效果不可预测。
胃手术后，DGE仍影响着相当数量的患者（24%），在糖尿病患者及营养不良、胃癌或胰腺癌患者中尤为常见。然而多数患者的胃动力在3至6周内恢复，因胃潴留进行再次手术的需求很少。
