基于心下痞论治消化道肿瘤术后胃瘫综合征
2025-08-15高天启吴汶霖刘新兰吴乾
【中图分类号】R256.31 【文献标志码】A 【文章编号】1007-8517(2025)12-0009-04
DOI:10. 3969/j. issn.1007 -8517. 2025.12. zgmzmjyyzz202512003
Abstract:Postsurgicalgastroparesis syndrome(PGS)isagastric motilitydisorder mainlycharacterizedbynon-mechanicalobstructivegastricptancedde.IspatogenesistillucleaanditslinicalfcacydprogosisetsatifactoyaditionalChinese medicinebelievesthatpatientswithdigestivetracttumorshavethespleenandstomachqideficiency,thespleenand stomacharedamagedafteroperation,andtheqimovementisdisordered,whichleadstothedisease.Thediseaseislocatedinthe spleen,withmixedcoldndeatandphlegmdampesandbloodstasis.Thepathogeesisissimilartotatofthehypocardialuppie recordedintheJoualofColdDisease.ThispaperdiscusesthetheoreticalbasisoftraditioalChinesemedicinetreatmentfgastroparesis syndromeaftergastrointestinaltumoroperationfromclinicalsymptoms,tiologyandpathogenesis,summarizesthesyndroofhy pocardialmass,andexplainstheclinicalprescriptionandmedicatioofGSincombinationwithclinicalclasiccases,providingnew ideas for traditional Chinese medicine treatment of PGS.
Keywords:PostoperativeGastroparesisSyndrome;GlomusBelowtheHeart;BanxiaXiexinDecoction;Gastrointestinal Tumors;Glomus
消化道肿瘤术后胃瘫综合征(postsurgicalgas-troparesissyndrome,PGS)是发生于消化道术后的一种胃动力障碍性疾病,指无机械梗阻因素下出现的以胃排空障碍为典型特征的临床综合征[1]临床多表现为早饱、进食后饱胀、呕吐、恶心、食欲下降与大量胃液持续增加等。常继发于胃癌根治术和胰十二指肠切除术后,是胃癌根治术后早期临床副反应之一[2],其发病率最高达
11.5%[3] ,已发展为肿瘤术后不可忽视的并发症。目前医学界对于PGS的具体发生机制尚无定论,有研究提示其发生与手术影响Cajal间质细胞数量及交感神经与迷走神经相关[4],此外,腹腔并发症、胃电活动传导障碍、精神因素[5]、血糖水平、低蛋白血症[6、术后胃肠激素紊乱也与术后胃瘫综合征的发生密切相关。
治疗方面,西医面对消化道PGS以减轻临床症状,纠正营养不良,去除疾病诱因为原则积极改善症状、提高生活质量。治疗上以药物治疗为主,临床常用促动力药与止吐药,如甲氧氯普胺、莫沙必利等,但其长期服用药物敏感性降低、药物毒副反应等皆导致临床疗效不甚理想[8]。除此之外,胃肠减压术、G-POEM等9非药物疗法也是术后胃瘫综合征的常见疗法,但因患者痛苦较大而难以长时间实施。近年来,包括针灸、穴位贴敷、中药口服等中医疗法因其副作用小、患者接受程度高,临床行之有效而逐渐得到推广。
术后胃瘫综合征在中医范畴内尚无明确病名,现代学者常据症状以“呕吐”“腹胀”“痞满”“食滞”等论治,其发病机制多与气机失常,脾胃受损,络脉损伤,升降失调相关。……
