CHẨN ĐOÁN VÀ ĐIỀU TRỊ HỘI CHỨNG CHẬM RỖNG DẠY DÀY SAU CẮT DẠ DÀY BÁN PHẦN DO UNG THƯ DẠ DÀY

Abstract

Study aim: 1. Clinical and paraclinical feature and risk factors  of delayed gastric emptying post  subtotal gastrectomy for gastric cancer. 2. Diagnosis, treatment of delayed gastric emptying. Patient and method: +Retrospective study. +Case report  (rare diseases). Result: There were 4 patients; 2 male,2 female,mean age: 65,5 Y (Range: 60-72 Y), the average onset time post gastrectomy 10,75 day (range 10-12 day); of them, 3 patients had diabetes, one had emotional stress and anxiety preoperation. The lesion per operation:1 had pyloric obstruction,3 patient had tumors located at the body or lesser curvature of stomach. Operation performed: Subtotal gastrectomy with billroth 2 reconstruction (Finsterer) and lymph node D2 dissection. Clinical manifestations  post gastrectomy: nausea, bloating, vomiting Plain Xrays: No hydro -air level, no intertinal obstruction. Barium serial  Xrays (Telebrix): post 6 h: retained telebrix in lumen of remnant anastomosis, the transit time more than 12h for emptying all telebrix, dilatation of remnant stomach, no mecanichal obstruction (Telebrix went downward to colon). All patients had medical treatment consisting of nutrient support and erythromycin with half dosage orally. 3 of them had good recovery,one had acupuncture and electromechanics acupuncture. The average hospital stay (post onset delayed gastric emptying): 6,75 day (range 5-12 day). Conclusion: Delayed gastric emptying post subtotal gastrectomy appeared on 10,75 days (average time). Risk factors included:  Type 2 diabetes, pyloric obstruction, location of tumor in the lower body of stomach or lesser curvature. Diagnosis: Barium serial Xrays showed retained barium (telebrix) intra lumen of stomach remnant post 6 h with remnant anatomosis dilatation. Treatment consisted of: Nutrition support, naso tube aspiration, oral erythromycin (low dosage) in combination with electromechanics acupuncture.