CAJ | 학술논문

目的：探讨食管癌、贲门癌术后胃瘫综合征的预防与非手术治疗方法。方法：本院2007年5月至2010年3月未采取系统性预防措施的573例为对照组,2010年4月至2013年6月采取了系统性预防措施的867例为观察组,包括术中保护胃,胸胃固定,胃肠减压,抑酸减少胃壁张力,肠内营养支持,避免抑制胃肠平滑肌收缩,保持水电解质和酸碱内环境平衡等措施。回顾分析两组食管、贲门癌术后胃瘫综合征的发生率；观察组的胃瘫病例采用非手术的综合性治疗措施,包括禁食水,持续胃肠减压,防误吸,给予温盐水洗胃,持续肠内营养,营养管再置入困难给予全静脉营养,胃动力药物,维持水电解质酸碱内环境平衡,监控血糖水平,胃镜下幽门扩张,中药管喂等措施。对照组未采取综合性治疗措施,回顾分析两组中胃瘫病例的临床治疗效果。结果：对照组573例患者发生27例胃瘫(4．71%)；观察组867例发生22例胃瘫(2．53%)。采取系统性预防措施后,胃瘫发生率明显降低( P=0．04)。观察组22例病例的症状均得到有效控制；无死亡病例；营养管留置时间平均48．35(17~69)天；平均住院时间53．23(19~71)天。对照组27例病例,误吸肺部感染死亡2例,吻合口瘘死亡3例,营养管留置时间平均50(20~71)天,平均住院时间54．71(24~78)天。采取非手术综合治疗后胃瘫病例未合并致死性并发症,营养管留置时间(P=0．02)与住院时间(P=0．03)明显缩短,患者明显获益。结论：食管癌、贲门癌术后胃瘫综合征可有效预防,可通过非手术综合性治疗获得满意的疗效。
목적：탐토식관암、분문암술후위탄종합정적예방여비수술치료방법。방법：본원2007년5월지2010년3월미채취계통성예방조시적573례위대조조,2010년4월지2013년6월채취료계통성예방조시적867례위관찰조,포괄술중보호위,흉위고정,위장감압,억산감소위벽장력,장내영양지지,피면억제위장평활기수축,보지수전해질화산감내배경평형등조시。회고분석량조식관、분문암술후위탄종합정적발생솔；관찰조적위탄병례채용비수술적종합성치료조시,포괄금식수,지속위장감압,방오흡,급여온염수세위,지속장내영양,영양관재치입곤난급여전정맥영양,위동력약물,유지수전해질산감내배경평형,감공혈당수평,위경하유문확장,중약관위등조시。대조조미채취종합성치료조시,회고분석량조중위탄병례적림상치료효과。결과：대조조573례환자발생27례위탄(4．71%)；관찰조867례발생22례위탄(2．53%)。채취계통성예방조시후,위탄발생솔명현강저( P=0．04)。관찰조22례병례적증상균득도유효공제；무사망병례；영양관류치시간평균48．35(17~69)천；평균주원시간53．23(19~71)천。대조조27례병례,오흡폐부감염사망2례,문합구루사망3례,영양관류치시간평균50(20~71)천,평균주원시간54．71(24~78)천。채취비수술종합치료후위탄병례미합병치사성병발증,영양관류치시간(P=0．02)여주원시간(P=0．03)명현축단,환자명현획익。결론：식관암、분문암술후위탄종합정가유효예방,가통과비수술종합성치료획득만의적료효。
Objective: To investigate the prevention and non-surgical treatment for postsurgical gastroparesis syn-drome in esophageal cancer or cardiac cancer patients. Methods:Between April 2010 and June 2013, the systematic pre-ventive measures were given to 867 patients ( observation group) who accepted operation for esophageal cancer or cardiac cancer in our hospital, which included intraoperative protection for the stomach, chest gastric fixation, gastrointestinal de-compression, acid suppression to reduce tension of stomach, enteral nutrition support, prevention from the inhibition of gas-trointestinal smooth muscle contraction, keeping balance for internal environment. Between May 2007 to March 2010, the systematic preventive measures were not given to the 573 patients ( control group) . The non-operative comprehensive treat-ment measures were given to gastric paralysis cases in observation group, which included fasting water, continuous gastroin-testinal decompression, prevention of regurgitation and aspiration, warm saline lavage, enteral nutrition, total parenteral nutrition in enteral nutrition failed cases, gastric dynamic drugs, maintaining internal environment balance, monitoring the blood sugar level, pyloric expansion under gastroscope, traditional Chinese medicine ( TCM) tube feeding, etc. The con-trol group did not accept comprehensive treatment measures. The clinical curative efficacy of gastric paralysis in the two groups were reviewed. Results:Twenty-seven cases of gastric paralysis occurred in the control group ( 4. 71%) , and 22 cases (2. 53%) in observing group. The incidence of gastric paralysis significantly decreased after systematic preventive measures was conducted (P =0. 04). The symptoms of 22 cases in observation group were control effectively. No death occured in this group. The average time of nutrition tube in-dwelling was 48. 35 ( 17 ~69 ) days; The average length of hospital stay was 53. 23 (19~71) days. In control group, 2 patients died of sever lung infection caused by regurgitation and aspiration, 3 patients died of anastomotic fistula. The average time of nutrition tube indwelling was 50(20~71) days, the average length of hospital stay was ( 24 ~78 ) 54. 71 days. Through non-surgical comprehensive treatments, no fatal complications was observed in gastric paralysis cases. The nutrition tube indwelling time (P=0. 02) and length of hospital stay (P=0. 03) were significantly shortened. Conclusion:Gastroparesis can be effectively prevented, and it is able to be cured through non-operative treatment .