泛影葡胺在胃癌术后不全性肠梗阻中的应用研究

常琦，訾永宏，张磊

（延安大学附属医院普外科，陕西 延安，716000）

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摘要：

目的 研究胃癌术后并发的暂时不全性肠梗阻患者进行泛影葡胺造影的可行性。方法 选取我院60例胃癌术后并发不全 性肠梗阻患者为研究对象，术后均行上消化道造影检查确认为不全性肠梗阻，收治时间为2014年10月至2016年10月，所有患者按造影剂类型分为泛影葡胺组（27例）和欧乃派克组（33例）。对比两组患者一般资料、手术切除方式、合并症以及、血生化指标，并进行术后因不全性肠梗阻行二次剖腹手术的风险因素和保护因素的Logistic 单因素、多因素分析。结果 两组患者性别、年龄及手术切除方式、术前合并证、既往手术史、术前新辅助治疗史、术前血红蛋白、术前总蛋白、术前白蛋白水平均无显著差异（P>0.05）；术后首次排气、排便时间及住院时间、因肠梗阻二次剖腹手术发生率有显著差异（P<0.05）。术后因不全性肠梗阻行二次剖腹手术与术后血红蛋白<120 g/L、术后总蛋白<55 g/L、术后白蛋白<36 g/L、手术时间>300 min、手术类型（姑息与根治）无关（P>0.05）；Logistic多因素回归分析结果显示：术后下地时间>3 d、行腹腔镜手术可降低术后因不全性肠梗阻行二次剖腹手术的发生率，术后行泛影葡胺造影检查与术后因不全性肠梗阻行二次剖腹手术直接相关（P<0.05）。结论 胃癌术后并发不全性肠梗阻的影响因素较多，并发不全性肠梗阻后行上消化道泛影葡胺造影检查不仅有助于明确诊断，并可有效促进肠梗阻再通。

关键词：泛影葡胺造影；不全性肠梗阻；Logistic 回归分析

中图分类号：R656.7文献标志码：A文章编号：2096-1413(2017)20-0009-03

Study of gastrografin on the postoperative incomplete gastric obstruction of gastric cancer
CHANG Qi, ZI Yong-hong, ZHANG Lei
(Department of General Surgery, the Affiliated Hospital of Yan``an University, Yan``an 716000, China)

ABSTRACT: Objective To study the feasibility of gastrografin in patients with postoperative incomplete gastric obstruction of gastric cancer. Methods From October 2014 to October 2016, 60 cases of patients with gastric cancer complicated with incomplete intestinal obstruction were selected as the study objects. All patients were diagnosed as incomplete intestinal obstruction by upper gastrointestinal imaging after operation, and were divided into gastrografin group (27 cases) and omeprazole group (33 cases) according to contrast agent type. The general data, surgical resection, comorbidities and blood biochemical indexes and Logistic single factor, the multivariate analysis of the risk factors of secondary laparotomy clue to intestinal were compared. Results There were no significant differences in the gender, age and surgical resection, preoperative syndrome, previous surgical history, preoperative neoadjuvant therapy history, preoperative hemoglobin, preoperative total protein and preoperative albumin levels in the two groups (P >0.05); the differences in the first postoperative ventilation, defecation time, hospitalization time and incidence of secondary laparotomy clue to intestinal between the two groups were significant (P<0.05). Postoperative incomplete intestinal obstruction was not related to the postoperative hemoglobin<120 g/L, postoperative total protein<55 g/L, postoperative albumin<36 g/L, operation time>300 min and surgical type (palliative and radical) (P>0.05); Logistic multivariate regression analysis showed that postoperative ambulation time >3 d, laparoscopic surgery could reduce the incidence of secondary laparotomy clue to intestinal, postoperative gastrografin angiography was directly related to the secondary laparotomy clue to intestinal (P <0.05). Conclusion There are lots of influential factors on the gastric cancer complicated with incomplete intestinal obstruction, the upper gastrointestinal gastrografin angiography not only can confirm the diagnosis and can effectively promote the recanalization of intestinal obstruction.
KEYWORDS: gastrografin angiography; incomplete intestinal obstruction; Logistic regression analysis

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