Causes Analysis And Treatment Of Postsurgical Gastroparesis Syndrome After Resection Of Gastric Carcinoma

Background and Objective:Postsurgical gastroparesis syndrome (PGS) is one of the most common complications after resection of gastric carcinoma. This study aim to investigate the possible clinical factors、diagnosis、treatment and prevention contributing to PGS after distal gastrectomy for gastric cancer through the retrospectively analysis of patients who had the PGS after distal gastrectomy for gastric cancer in department of gastrointestinal surgery in Qilu Hospital of Shandong University in the past 5 years.Methods:Through the retrospectively analysis of 1350 patients who had the distal gastrectomy for gastric cancer in department of gastrointestinal surgery in Qilu Hospital of Shandong University from 2010 July to 2015 July, there was 46 cases of PGS. The incidence of PGS was 3.41%(46/1350). Among them,25 cases were male patients while 21patients were female patients (the M:F=1.2:1). Their ages rang from 25 to 80 years old and the average age was 61.02 years old. We choose 14 factors which can cause the PGS possibly. These factors including patients’ sex, age, preoperative anemia, pyloric obstruction, neoadjuvant chemotherapy before operation, hypoalbuminemia surround operation period, operation method choice (laparoscopic or laparotomy), digestive tract reconstruction (Billroth Ⅰ or Billroth Ⅱ), high blood sugar after operation (≥8mmol/L), amount of bleeding during operation, the operation duration time, the time to use enteral nutrition after operation, postoperative analgesia pump using, postoperative abdominal complications. According to these above factors, they were divided into PGS group and non PGS group. Use the IBM SPSS 21.0 software to perform the single factor chi-square test and find out the possible risk factors. Then use the Logistic Regression model to analyze influence of these factors to the PGS.Results:Through the retrospectively analysis of 46 patients who had the PGS, the incidence rate is 3.41%(46/1350). The onset time was 5d-15d. All cases were recovered after the conservation treatment of mainly through enteral nutrition support and none was performed a second operation,34 cases’(74%) gastrointestinal mobility were recovered in 6 weeks after operation,11 cases’(24%) gastrointestinal mobility were recovered in 8 weeks after operation,1 cases’(2%) gastrointestinal mobility were recovered in 11 weeks after operation. The single factor analysis showed that preoperative anemia, pyloric obstruction, hypoalbuminemia surround operation period, digestive tract reconstruction, high blood sugar and postoperative abdominal complications were the risk factors on PGS (P<0.05). Logistic Regression analysis showed that preoperative anemia, pyloric obstruction, hypoalbuminemia (ALB< 30g/L) surround operation period, digestive tract reconstruction, high blood sugar and postoperative abdominal complications were the risk factors on PGS (OR>1,P< 0.05), while hyperalbuminemia (ALB>30g/L) was the protective factor on PGS.Conclusions:There is not a uniform conclusion about the causes of the PGS. It is caused by several reasons. The single factor analysis showed that anemia, pyloric obstruction, hypoalbuminemia surround operation period, digestive tract reconstruction, high blood sugar and postoperative abdominal complications were the risk factors on PGS. Logistic Regression analysis showed that preoperative anemia, pyloric obstruction, hypoalbuminemia (ALB< 30g/L) surround operation period, digestive tract reconstruction, high blood sugar and postoperative abdominal complications were the risk factors on PGS, while hyperalbuminemia (ALB>30g/L) was the protective factor on PGS. In response to these risk factors, take relevant measures in preoperative, intraoperative and postoperative time, which can effectively reduce the occur of PGS after subtotal gastrectomy. The conservation treatment is the most important treatment method at present now. Application of enteral nutrition and promoting gastric dynamic medicines and acupuncture treatment for PGS patients have good effects. A second operation should be avoided if mechanical obstruction is excepted. Psychological comfort also plays an important role in the treatment of patients with PGS.