What are the common complications after subtotal gastrectomy?

1. Gastrorrhagia: After subtotal gastrectomy, a small amount of dark red or brown bloody contents can be discharged from the gastric tube within 24 hours, mostly due to residual blood in the stomach during operation or a small amount of leakage from the wound surface of gastrointestinal anastomosis, which is a normal phenomenon after operation. If a large amount of blood, especially blood, is discharged from the stomach tube in a short time, even hematemesis, melena and hemorrhagic shock may occur in severe cases, but in a few cases, the ligation or suture of small blood vessels at the cutting end or anastomosis is not tight enough; Obstruction of gastric mucosa by forceps or incomplete hemostasis of open duodenal ulcer leads to bleeding. Bleeding may also be secondary, that is, it occurs a few days after operation, mostly caused by tissue necrosis and ligation suture falling off due to ligation or suture tightening. Severe early bleeding, even shock, requires decisive re-exploration to stop bleeding. Secondary bleeding is not very serious, and most of them can stop bleeding by themselves after conservative treatment. 2. Duodenal stump rupture: this is the most serious complication of Bilo type in subtotal gastrectomy, with high mortality, about 10~ 15%. This complication usually occurs 4-7 days after operation. It is characterized by sudden and severe pain in the right upper abdomen, obvious tenderness, rebound pain, abdominal muscle tension and other symptoms of local or total abdominal peritonitis. The prevention method is: properly suture the duodenal stump. Once the stump is broken, surgical repair is difficult to succeed, and drainage should be carried out immediately. Protect the skin around the wound from digestive juices. Maintain water-electrolyte balance and adequate nutrition through intravenous nutrition or jejunostomy with high nutritional liquid food. In addition, antibiotics should be used to prevent and treat abdominal infection. If it is caused by loop obstruction of the input jejunum, it is feasible to anastomose the input jejunum with the output jejunum to relieve the obstruction. After surgery, many people can heal themselves. 3. Gastrointestinal anastomotic rupture or fistula: mostly occurred 5-7 days after operation. If it happened within 1-2 days after operation, there was no suture at all. Generally speaking, it is mostly caused by improper suture, excessive anastomotic tension, local tissue edema or hypoproteinemia. The rupture of gastrointestinal anastomosis often causes severe peritonitis. If peritonitis is caused by rupture of anastomotic stoma, it should be repaired immediately, which can be successful. However, reliable gastrointestinal decompression must be maintained after operation, and support treatment such as blood transfusion and infusion should be strengthened. If the anastomotic rupture occurs late and an abscess or fistula has formed locally, besides drainage, gastrointestinal decompression and supportive treatment are needed. Generally speaking, anastomotic leakage can heal itself within a few weeks. If it does not heal for a long time, you should consider gastrectomy again. 4. Obstruction after subtotal gastrectomy: Biloxi type ⅰ anastomosis after subtotal gastrectomy has less chance of obstruction, and only occasional anastomotic obstruction. If Biloxi anastomosis is used, there will be more chances of obstruction, which is described as follows. (1) Anastomotic obstruction: The incidence rate is about 1~5%, which is mainly manifested as epigastric pain and vomiting after eating. The vomit is food, mostly without bile. It is difficult to diagnose the nature of obstruction for a while, so we should take non-surgical treatment first, temporarily stop eating, place gastrointestinal decompression and intravenous infusion to maintain water and electrolyte balance and nutrition; Obstruction caused by mucosal inflammation and edema can often be improved within a few days. After two weeks of non-surgical treatment, abdominal distension and vomiting still occur after eating, so surgical treatment should be considered. (2) Infusion jejunal loop obstruction: The clinical manifestations are 15~30 minutes after eating, abdominal fullness, mild nausea and severe vomiting. Vomiting is mainly bile and generally does not contain food. After vomiting, the patient felt relieved and comfortable. Most patients gradually recover after several weeks of operation, and a few patients with severe and persistent symptoms need surgery. Barium meal examination showed that a large amount of barium entered the proximal jejunum cavity. For a few patients with persistent symptoms, reoperation can be performed in the same way as jejunal loop obstruction. All the above cases are simple obstruction. The other kind of obstruction is more serious, and strangulation often occurs. The main manifestations are upper abdominal pain, vomiting, vomit without bile, and sometimes the right upper abdomen can touch the mass. This kind of obstruction can easily develop into strangulation and should be treated by surgery very early. (3) Output jejunal loop obstruction: The main manifestation is vomiting, and the vomit is food and bile. Diagnosis should show the location of obstruction by barium meal examination. Severe symptoms should be treated surgically to relieve obstruction. 5. Dumping syndrome after subtotal gastrectomy: Dumping syndrome is a common complication after subtotal gastrectomy. It is more likely to occur in Biloxi anastomosis. Clinical dumping syndrome can be divided into early dumping syndrome and late dumping syndrome. (1) Early dumping syndrome: manifested as abdominal distension, palpitation, sweating, dizziness, vomiting and diarrhea after eating. The patient is pale, his pulse is quickened and his blood pressure is slightly higher. The above symptoms can be improved and disappeared by lying flat for 30~45 minutes. If patients eat in supine position, dumping symptoms often do not appear. The occurrence of symptoms is related to the nature and quantity of food. Eating sweets and milk is easy to cause symptoms, and overeating often causes symptoms. (2) Late dumping syndrome: Different from the early syndrome, it usually occurs about half a year after operation, but it usually occurs 2 to 3 hours after eating, showing fatigue, sweating, hunger, drowsiness, dizziness and so on. To prevent the occurrence of dumping syndrome, it is generally believed that gastrectomy should not be too much, residual stomach should be properly fixed, and gastrointestinal anastomosis should not be too large. Eat less and eat more meals in the early postoperative period, so that the gastrointestinal tract can gradually adapt. Once symptoms appear, they are gradually relieved or disappeared through diet adjustment. Very few patients with severe symptoms who have not improved after years of non-surgical treatment may consider reoperation. Reduce gastrointestinal anastomosis, or change Biloxi II type to Biloxi I type, or use jejunum for stomach, jejunum and duodenum anastomosis. 6. Anastomotic ulcer: Anastomotic ulcer is a common long-term complication after subtotal gastrectomy. The incidence rate is about 1~8%. Most of them occur after duodenal ulcer surgery. Preventive measures: avoid simple gastrojejunostomy; In subtotal gastrectomy, gastrectomy is enough, and gastroduodenal anastomosis is needed. Anastomotic ulcer generally advocates surgical treatment. The surgical method is subtotal gastrectomy or vagotomy at the same time. 7. Alkaline reflux gastritis: Alkaline reflux gastritis is a special type of lesion after subtotal gastrectomy, with an incidence of about 5-35%, which often occurs 65,438+0-2 years after Biloxi subtotal gastrectomy. The main clinical manifestations are: persistent burning pain in the upper abdomen, aggravated symptoms after eating, and ineffective antacids; Bile vomiting, symptoms do not relieve after vomiting, gastric juice analysis of gastric acid deficiency; Loss of appetite, weight loss and gastritis often cause long-term small amount of bleeding and lead to anemia. Gastroscopy showed chronic atrophic gastritis. Non-surgical treatment of this complication is ineffective. If the symptoms are serious, surgery should be considered. Koux-eh-y anastomosis can be used to prevent bile from flowing back to the remnant stomach, and vagotomy can be used to prevent anastomotic ulcer after operation, with good results. 8. Nutritional disorders: After subtotal gastrectomy, a few patients may have nutritional disorders such as emaciation and anemia. (1) emaciation: After subtotal gastrectomy, patients have more frequent stools, mostly loose stools, and the stools contain undigested fat and muscle fibers, which makes patients eat less calories and lose weight gradually. The treatment is mainly to adjust the diet and pay attention to the calorie and nutritional value of the diet. Give pepsin, pancreatin or multienzyme preparation. (2) Anemia: After subtotal gastrectomy, iron-deficiency erythrocytic anemia appeared. A few patients lack endogenous anti-anemia factors, which hinders the absorption of vitamin B 12 and leads to nutritional megaloblastic anemia. The former was given iron, while the latter was given vitamin B 12.