Physiological _'s prevention and health care of pathology after the gastric carcinoma operation

Physiological _'s prevention and health care of pathology after the gastric carcinoma operation
It is that the surgery treats the daily surgery method of gastric carcinoma that the stomach is excised. It employs a more one to be near carrying stomaching, excising, excising with lymph node cleaning skilling with the whole stomaching mostly far usually. Because incomplete only remaining a lot of stomaches and, digestion, absorption and nutrition obstacle of patient's diet of direct influence,etc..



A stomach excises the postoperative pathologic physiology mostly



After the stomach is excised mostly, because the body of stomach is reduced, the incomplete stomach capacity is diminished, and lose regulating action of pylorus, the stomach empties time to shorten, because of losing and secreting the gastric acid to organize in a large amount, in addition after the gastrointestinal tract are rebuilt, the incomplete stomach is taken the form of low and sour or does not have and sour, not merely influence patient's nutrition and digesting and supersession, and pancreas the intersection of gallbladder and liquid return to, flow or mix, lead to the fact incomplete the intersection of stomach and pH increase notably, make incomplete stomach and there are a large number of cells that have bred and held in the jejunum, help N - inferior nitre base compound to formate in the stomach, will form in the future incomplete gastric carcinoma will take place etc.. But because skill types that the gastrointestinal tract rebuild are different after the stomach is excised mostly, the impact on organism is not all the same. The following whether we excise, observe and consult other similar stomach, excise, study the situation while being postoperative mostly while being postoperative mostly to 43 stomach 1960~1963 year:



( 1) The postoperative situation of having meal: According to the intersection of animal and experimental observation, incomplete the intersection of stomach and in can produce little to shrink wave while being postoperative muscle, the stomach peristaltic wave appears in 4~6 hours, the postoperative small intestine has peristaltic waves promptly, but chicken's sound of intestines is needed appears while there are liquid content things, absorb to glucose intestine have, absorb function promptly postoperative 1 hour, so someone propose, need stomach tube can't help proposal of the food while being postoperative. The target who we study is the patient from half year after the operation to three and a half years, the general meal person of daily breakfast,lunch and dinner, the person who finishes type is 100%, the person who finishes 2 is 85.7%.



( 2) Appetite: Type or 2 type intestines and stomach are identical to finish, postoperative every meal appetite of three months is in 150~200g.



( 3) The stomach empties time: Finish the intersection of type and the intersection of operation and stomach empty 17~30 minutes, generally greatly admire the disease group; Finish the 2 type stomach and empty time for 7~30 minutes, person who pours out disease group is 25%~50%. It makes the food unable to shut with the abundant companion of gastric juice in the stomach that the empty time of calf of the leg of stomach is shortened, can't stimulate the corresponding pancreas gallbladder liquid to secrete in a large amount, influence the digestive function of the gallbladder liquid of pancreas either.



( 4) The incomplete gastric juice is checked: Common and postoperative without the free acid. The gastric juice pH5.8 is 7.4. Reason its besides losing a large number of stomaches which secrete the gastric acid to organize, 12 mean intestinal juice guide from foot-path to incomplete stomach or return to and flow into the incomplete stomach to play an extremely important role. Present low and sour after gastric carcinoma or stomach excises mostly or have gastric acid, bacterium swallowed to play can breed, up to 106 ml in stomach, among them nitrate is relatively reduced more, make nitrate reduce for inferior nitrate, and the stomach can be the inferior amine synthetic and carcinogenic and very strong N - inferior nitre base compound that nitrify. In addition because of achlorhydria, the absorption obstacles or supersession of iron and vitamin C are not good, the inner factor is produced and influenced, cause low hemochrome anaemia to be up to 38.9%.



( 5) The stomach excises the postoperative supersession to change mostly: Excise postoperative detection mostly according to our stomach, no matter finish or finish the 2 type operation, balanced that it presents and shoulders nitrogen. But report 55.6% can reach nitrogen balanced or straight balanced nitrogen. Gastric carcinoma effect a radical cure, treat postoperative protein, dawdle, lose, increase, result from the reason that the overall albumen is decomposed and increased fast, intravenous nutrition stands and can not inhibit protein from decomposing. Especially can only not according to at present at being clinical conventionally fluid infusion intravenous, cards hot not offered glucoses involved in maintaining the nerve centre and red cellular metabolism under fasting, and the tissue can only store to repair necessary nitrogen through utilizing organism, so not merely can change protein decomposing rate, and often lead to the fact internal proteins decompose and shoulder nitrogen in a large amount balanced. But observe in the gastric carcinoma operation on later stage, because of excising tumour, dispelled the abnormal metabolism of tumour, can take in nutrient normal supersession and utilize organism, can also present nitrogen in the hope of being improved to be balanced. Generally increase from the fat quantity of discharging in the excrement and urine than the control group, observe according to the oil acid of the radioactive iodine mark: Indigestion that the stomach part excises the postoperative fat and utilizes the obstacle to be mainly the fat, instead of absorbing the question, because the deficiency of time that food fully mix with bile and pancreatic juice of perhaps this. It finish 2 skill is getting apter to influence food not to be mixed more with bile and pancreas enzyme and led to the fact than lasting skilling and among food incongruous, therefore finish the 2 type postoperative fat more incident and rush down.



( 6) The weight is changed: The weight changes every report and differs, think is a common phenomenon that the weight drops after stomaches are excised. Very person the patient can lose the ability to work because of this. Report weight while resuming or exceeding and is strong in 40%. Generally speaking, all in the balanced or straight nitrogen equilibrium state person of nitrogen, the weight has not dropped, can resume original work.



( 7) The postoperative immunological function of gastric carcinoma: The decline that has already stated gastric carcinoma patient's immunity ago is the body fluid and it is damaged that cells have been immune and overall. Develop issues of the intersection of gastric carcinoma and natural killer cell (NKC) T of activity and gastric carcinoma patient assists cells to be lower than normal people notably. Serum IgG, IgA, IgM level are reduced, and drop with condition progress. The operation can increase the patient's consumption as a kind of wound, weaken the whole immune ability of the organism, but this kind of damage is the passing. Because operation should defy immunity that cause inhibit from in postoperative the 10th day already basically resuming, in postoperative 10 day IgG, IgA, rise than skill by IgM. The intersection of cell and improvement of immunological function, the intersection of person of gastric carcinoma briefed on and competent rise of immunity under surgery of effecting a radical cure etc., indicate, carry on one's shoulder or back the intersection of tumour and organism, relieve tumour, behind the load, inhibit the factor after dispelling the source immunity of tumour, having increased the patient's ability to resist tumour, so the operation radically treats or reduces the tumour body operation it is beneficial to the patient. Employ nutrition support (TPN) while being postoperative The formating rate of albumen of the persons who can obviously improve the operation future trouble of gastric carcinoma, promote the immunity that the operation cause to inhibit the material base that the state resumes.



2 the whole stomach excises the postoperative pathologic physiology



The whole stomach excises and treats gastric carcinoma to start in 1897 (Schlatter) . Because operation mortality is up to 40%~50%, postoperative nutrition keeps difficult, is given up not using for a time. But observe according to the contrast of natural course of disease and different therapeutic method of gastric carcinoma: Survival rate treat group as zero 5 year, cut open belly, ascertain 4.17% group, short out 6.45% surgery, person who condone gastric carcinoma excises 16.6%, the whole stomach excises 50%, effecting a radical cure gastric carcinoma excises 55%. Though the whole stomach is excised and used in gastric carcinoma patients of extensive later period more, operation mortality drops to below 5% in 35%~83% more in its survival rate of 5 years, in addition the improvement of reconstruction surgery, so the increasingly many person maintains in recent years that implements the whole stomach to excise and treat gastric carcinoma. Having so not merely prevented the omission of many centre gastric carcinomas, in addition formate in the stomach from inferior nitre amine of cause of disease of gastric carcinoma, the whole stomach excises function preventing incomplete gastric carcinomas from taking place. But after the whole stomach is excised
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