Post-gastrectomy Syndrome
Post-gastrectomy Syndrome
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胃切除术后综合症
DOI：
10.1136/bmj.2.4836.598
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发表时间：
1953
影响因子：
--
通讯作者：
P. Anderson
中科院分区：
文献类型：
--
作者：
J. Schofield;P. Anderson
关于早期胃切除术后综合征，最近已有很多文章。当我们考虑到今天胃十二指肠溃疡的Polya型胃部分切除术的数量时，这并不奇怪。目前，一种新的疾病正在形成，通常被称为“倾倒”或胃切除术后综合征，由不同性质和严重程度的症状组成。随着时间的推移，病情较轻的情况有所改善，但严重的情况仍然存在，我们关注的正是这些情况。倾倒综合征的程度如何，这些患者会发生什么？人们经常听说，这种综合症只发生在一小部分病例中，而这些病例往往会自行恢复。卡斯特、巴特和沃（1946）认为，除了最轻微的病例外，所有病例都无限期地持续下去，而且症状可能非常严重和致残，以至于有必要使用”胃瘫痪“一词。Capper和Butler（1951）在检查558例Polya型胃切除术的结果时发现，79例出现早期综合征，其中61例的症状持续2 ~ 11年。Goligher和Riley（1952）报道，术后6个月75%的病人发生倾倒，其中重度倾倒占12.5%;术后18个月仍有倾倒者占47.5%，重度倾倒占10%。另一些人认为这个比例并不高，但我们建议对每个胃切除术后患者进行个人研究，将在很大比例的病例中揭示出该综合征的一些证据。严重的病例，由于他们定期参加后续诊所，可能是最令人不安的，对其他病人毫无帮助。当我们考虑到消化性溃疡手术的规模时，这些不幸的人的数量一定很大。此外，这一手术通常是为处于工资收入最高水平并有家庭要供养的男子进行的。如果由于倾倒综合征，他们不能回到他们的术前职业，那么胃切除术不能被认为是成功的。本文初步报告了十二指肠溃疡Polya型胃切除术后早期胃切除综合征。我们的经验很一般，并且，面对如何处理少数严重“倾倒者”的问题，我们决定遵循Illingworth的手术（Muir引用，1949年），他通过外侧吻合成功治疗了三例病例。空肠的输出和输入环路。我们的病人欣然接受了摆脱悲惨状况的机会。在我们的一系列结肠前Polya胃切除术中，使用Hofmeister阀，发生了7例持续严重的“倾倒”，这对患者和我们自己都是非常痛苦的。这些患者（5名男性，2名女性）均接受了空肠传出和传入袢之间的吻合术。6例因十二指肠溃疡行胃切除术，1例因胃溃疡行胃切除术。他们的症状可以方便地分为四个标题：1。呕吐胆汁。-所有患者都抱怨这种令人痛苦的症状。呕吐从一至thfee次，每天，食物后，和数量从5至20盎司。(140至570 ml.）一次。2.血管舒缩症状。- 4例患者主诉进食后严重出汗和头晕。不得不躺下直到发作过去。
Much has been written recently about the early postgastrectomy syndrome. This is not surprising when we consider in what large numbers the Polya type of operation of partial gastrectomy is being undertaken to-day for gastroduodenal ulceration. For the moment a new disease is being created, commonly referred to as the" dumping" or post-gastrectomy syndrome, consist-ing of symptoms varying in character and severity. The milder cases improve with the passage of time, but the severe ones remain, and it is with these that we are concerned. What is the extent of the dumping syndrome, and what happens to these patients? One so frequently hears that the syndrome occurs in only a small percentage of cases which often right themselves. Custer, Butt, and Waugh (1946) thought that all but the mildest cases lasted indefinitely, and that the symptoms could be so severe and disabling as to warrant the use of the term" gastric cripple." Capper and Butler (1951), in examining the results of 558 Polya type of gastrectomies, found that 79 cases showed the early syndrome, and that 61 of these had symptoms lasting from two to eleven years. Goligher and Riley (1952) reported that six months after operation dumping occurred in 75% oftheir patients, whichwas severe'in 12.5%, and that eighteen months after operation 47.5% still had dumping and 10% severe dumping. Others maintain that the percentage is not so high, but we suggest that a personal study of each postgastrectomy patient will reveal some evidence of the syndrome in a large proportion of cases. The severe cases, by reason of their regular'attendance at a followup clinic, can be most disconcerting and not at all helpful to other patients. When we consider the scale upon which the operation for peptic ulcer is being performed, the number of these unfortunate people must be large. Moreover, the operation is undertaken for men usually at the height of their wage-earning capacity and with a family to support. If, as a result of the dumping syndrome, they are unable to return to their preoperation occupation, then the operation of gastrectomy cannot be regarded as a success. This paper-a preliminary report-deals with the early post-gastrectomy syndrome following the Polya type of gastrectomy for duodenal ulcer. Our experience has been an average one, and, confronted by the problem of what to do for a small number of severe" dumpers," we decided to follow the procedure of Illingworth (quoted by Muir, 1949), who treated three cases success-fully by lateral anastomosis of the efferent and afferent loops of the jejunum. Our patients readily accepted the opportunity of being rid of their miserable condition. Lateral AnastomosisIn our series of antecolic Polya gastrectomies with a Hofmeister valve seven cases of persistent severe" dump-ing" occurred, which was, very distressing both to the patients and to ourselves. These patients (five male, two female) were all submitted to an anastomosis between the efferent and afferent loops of the jejunum. Six had a gastrectomy for duodenal ulcer and one for a gastric ulcer. Their symptoms can be grouped conveniently under four headings: 1. Vomiting Bile.-All patients complained of this distressing symptom. Vomiting varied from one to thfee times a day, after food, and in amounts from 5 to 20 oz.(140 to 570 ml.) at a time. 2. Vasomotor Symptoms.-Four patients complained of severe sweating and dizziness after food. and had to lie down until the attack had passed off.