摘要
目的探讨腹腔镜胃癌根治术后内疝的临床特点及处理方法。方法回顾性分析2010年1月至2018年6月扬州大学附属苏北医院(江苏省苏北人民医院)实施腹腔镜胃癌根治Roux-en-Y吻合术后发生内疝的27例患者的临床资料。结果 27例内疝患者均行腹腔镜胃切除Roux-en-Y吻合,其中25例全胃切除、2例远端胃切除。上腹部疼痛伴恶心、呕吐是其主要的临床表现。发病时间为术后6 d至5年,1年以内发病者15例(55. 6%)。其中23例行手术治疗,6例死亡;4例保守治疗,1例死亡;总病死率为25. 93%。结论内疝是一种罕见的、不易诊断的严重并发症。为预防腹腔镜胃切除术后内疝,若技术条件允许,可常规关闭系膜裂孔。临床上,一旦疑似内疝,应早期行腹腔镜探查。
Objective To investigate clinical characteristics and management of internal hernia after laparoscopic gastrectomy.Methods The clinical data of 27 patients who underwent laparocopic gastrectomy for gastric cancer with Roux-en-Y reconstruction from Jan.2010 to Jun.2018 Northern Jiangsu Province Hospital,Clinical Medical College,Yangzhou University were retrospectively analyzed.Results Among the 27 patients with internal hernia,25 patients underwent laparoscopic total gastrectomy with Roux-en-Y reconstruction,and 2 patients underwent laparoscopic distal gastrectomy with Roux-en-Y reconstruction.The main manifestations are severe pain in upper abdomen with nausea and vomiting.The time of onset was 6 days to 5 years after surgery,and 15 cases occurred within 1 year(55.6%).Among them,23 patients received surgical treatment and 6 died,4 patients received conservative treatment and 1 died.The total mortality rate was 25.93%.Conclusions Internal hernia is a rare and serious complication that is difficult to diagnose.It is necessary to close mesenteric defects to prevent abdominal hernia,during laparoscopic radical gastrectomy for Roux-en-Y anastomosis.Clinically,early surgical treatment is essential when it is suspected.
作者
李智
汪刘华
汤东
王伟
金芝祥
徐明皓
吴晓清
张琪
王道荣
Li Zhi;Wang Liuhua;Tang Dong;Wang Wei;Jin Zhixiang;Xu Minghao;Wu Xiaoqing;Zhang Qi;Wang Daorong(Dalian Medical University,Dalian 116044,China;Department of General Surgery,General Surgery Institute of Yangzhou,Northern Jiangsu Province Hospital,Clinical Medical College,Yangzhou University,Yangzhou 225001,China;School of Medicine,Yangzhou University,Yangzhou 225009,China)
出处
《中华腔镜外科杂志（电子版）》
2019年第1期62-64,共3页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
基金
江苏省第五期"333工程"培养资金资助项目(BRA2017153)
