Novel surgical treatment and gastric pathology in diabetic gastroparesis
Novel surgical treatment and gastric pathology in diabetic gastroparesis
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DOI：
10.1046/j.1464-5491.1999.00086.x
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发表时间：
1999-06-01
影响因子：
3.5
通讯作者：
Watkins, PJ
中科院分区：
文献类型：
--
作者：
Ejskjaer, NT;Bradley, JL;Watkins, PJ
目的观察4例1型糖尿病患者胃轻瘫合并难治性呕吐的罕见综合征，确定根治性手术是否能缓解其症状，并详细检查胃组织病理学。方法手术入路包括切除约70%的胃，包括胃窦和幽门，关闭十二指肠，并通过60厘米的Roux-en-Y空肠袢恢复胃肠道连续性。4例长期1型糖尿病患者进行了检查和治疗。他们都是年龄在27-41岁之间的女性，自主神经功能测试严重异常，排除了胃轻瘫的其他原因。结果4例患者中有3例手术前一年呕吐导致多次住院（6-8次），而第4例患者手术成功后因肾功能衰竭需要透析。胃组织病理学显示平滑肌变性和纤维化，并伴有嗜酸性包涵体（M-bodics），这似乎是这种疾病所特有的。检查结果提示存在胃肌病。结论：一种新的根治性手术方法使糖尿病性胃轻瘫的难治性呕吐得到了满意的缓解，组织病理学结果表明，胃肌病可能与该综合征的产生有关。
Aims Observations are made on four Type 1 diabetic patients with the rare syndrome of intractable vomiting from confirmed gastroparesis, to determine whether radical surgery would alleviate their symptoms and subsequently to examine in detail the gastric histopathology.Methods The surgical approach consisted of an approximate to 70% resection of the stomach, including the antrum and pylorus, with closure of the duodenum and restoration of gastrointestinal continuity with a 60-cm Roux-en-Y jejunal loop. Four longstanding Type 1 diabetic patients were examined and treated as described. They were all women in the age range 27-41 years with grossly abnormal autonomic function tests in whom other causes for gastric paresis had been excluded.Results Vomiting episodes leading to multiple hospital admissions (6-8) in the year preceeding surgery were eliminated in three of the four patients, while in the fourth initial success was followed by the need for dialysis for renal failure. Gastric histopathology showed evidence of smooth muscle degeneration and fibrosis, with eosinophilic inclusion bodies (M-bodics) which appear to be unique to this condition. The findings suggest the presence of a gastromyopathy.Conclusions Satisfactory relief of intractable vomiting from diabetic gastroparesis was achieved by a novel radical surgical procedure, Histopathological findings suggest that gastromyopathy may contribute to the production of this syndrome.