中国普外基础与临床杂志

中国普外基础与临床杂志

甲状腺功能减退合并右半结肠癌根治术后胃瘫综合征MDT诊疗经验

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目的 总结 1 例甲状腺功能减退合并右半结肠癌根治术后胃瘫综合征的临床诊治过程及经验。 方法 对笔者所在医院近期收治的 1 例甲状腺功能减退合并右半结肠癌根治术后胃瘫综合征患者开展普通外科、内分泌科、营养科、放射科及病理科专家参与的多学科协作(MDT)会诊讨论。 结果 MDT 讨论结果认为,该例患者术前诊断右半结肠癌明确,行右半结肠癌根治术后出现胃瘫综合征,且患者术前合并有甲状腺功能减退,胃瘫的发生可能与甲状腺功能减退有关,建议在术后补充甲状腺素钠、营养支持治疗。按照 MDT 讨论结果,在胃瘫发生后给予补充甲状腺素钠、营养支持治疗,患者胃瘫逐渐治愈,顺利出院。 结论 甲状腺功能减退可能是右半结肠癌根治术后胃瘫综合征发生的高危因素之一,MDT 机制可为甲状腺功能减退合并右半结肠癌根治术后胃瘫综合征的患者提供个体化的优选治疗方案,使患者获益。

Objective To summarize clinical diagnosis and treatment of 1 case of hypothyroidism complicated with postoperative gastroparesis syndrome (PGS) after radical resection of right colon cancer. Method The multi-disciplinary (MDT) mechanism was used to discuss the MDT consultations of the departments of general surgery, endocrinology, nutrition, radiology, and pathology in a patient with hypothyroidism and right colon cancer after the radical resection. Results The MDT discussion concluded that the patient had a clear diagnosis of right colon cancer before the surgery, and the PGS occurred after the radical resection of right colon cancer. The patient had the hypothyroidism before the operation, and the occurrence of PGS might be related to the hypothyroidism. The experts of MDT recommended to treat with the thyroxine sodium and nutritional support treatment after the surgery. According to the results of the MDT discussion, the patient’s PGS was gradually cured and discharged smoothly after the thyroxine supplementation and nutritional support. Conclusions Hypothyroidism may be a risk factor for occurrence of PGS after radical resection of right colon cancer. MDT mechanism can provide an individualized optimal treatment for patients with hypothyroidism complicated with PGS after radical resection of right colon cancer and benefit these patients.

关键词: 多学科协作; 甲状腺功能减退; 右半结肠癌; 胃瘫综合征

Key words: multi-disciplinary; hypothyroidism; right colon cancer; postoperative gastroparesis syndrome

引用本文: 江恩来, 王帅, 邱远, 张瑞, 王光宪, 唐雪峰, 白倩, 杨桦, 肖卫东. 甲状腺功能减退合并右半结肠癌根治术后胃瘫综合征MDT诊疗经验. 中国普外基础与临床杂志, 2018, 25(11): 1366-1371. doi: 10.7507/1007-9424.201807066 复制

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1. 邹宏雷, 杜鹃. 腹部手术后胃瘫的诊治分析23例报道. 中国普外基础与临床杂志, 2012, 19(10): 1148.
2. Diaz A, Lipman Diaz EG. Hypothyroidism. Pediatr Rev, 2014, 35(8): 336-347.
3. 高琪, 吴云桦, 陈南征, 等. 胃癌术后影响胃瘫发生的多因素分析. 中国普外基础与临床杂志, 2016, 23(8): 926-930.
4. Meng H, Zhou D, Jiang X, et al. Incidence and risk factors for postsurgical gastroparesis syndrome after laparoscopic and open radical gastrectomy. World J Surg Oncol, 2013, 11: 144.
5. 罗应超, 陈国强, 张金强. 结肠癌术后胃瘫早期肠内营养患者的效果分析. 岭南急诊医学杂志, 2015, 20(3): 198-199.
6. 刘特彬, 李晓辉. 结直肠癌根治术后胃瘫综合征21例诊治分析. 中华普通外科学文献(电子版), 2011, 5(4): 312-314.
7. 宋彬, 苏妍卓, 舒振波, 等. 远端胃切除术后胃瘫综合征的危险因素分析. 中国普外基础与临床杂志, 2016, 23(1): 94-96.
8. Zheng LJ, Ma JC, Fang D, et al. The quantification and assessment of depression and anxiety in patients with postoperative gastroparesis syndrome. Ther Clin Risk Manag, 2018, 14: 551-556.
9. 刘德连, 张学伟, 吕方启. 胃癌术后胃瘫发生的影响因素分析. 中华肿瘤杂志, 2017, 39(2): 150-153.
10. 陈海军. 手术后胃瘫的诊断与治疗. 中国普外基础与临床杂志, 2003, 10(6): 608-609.
11. 张蓬波, 任泽强. 腹部手术后胃瘫综合征的临床诊治. 中国普外基础与临床杂志, 2010, 17(9): 976-977.