胃大部切除术后吻合口后疝14例分析

Retrostomal internal hernia complicating Billroth Ⅱ subtotal gastrectomy:report of 14 cases

目的探讨胃大部切除术后发生吻合口后疝的原因以及诊断、治疗和预防措施。方法回顾性分析１９７５～１９９７年诊治的１４例胃大部切除术后吻合口后疝的资料。结果１４例皆并发于ＢｉｌｒｏｔｈⅡ式胃肠吻合术后，其中属结肠前吻合者１２例（输入袢长１６～２５ｃｍ）；结肠后吻合者２例（输入袢长１０～１４ｃｍ）；治愈１０例，死亡４例（２８％）。结论胃大部切除吻合口后疝术前诊断极困难，一旦确诊应尽早手术治疗。预防胃大部切除吻合口后疝的关键是消除吻合口后裂隙，正确选择输入袢长度。

Objective To investigate the cause,diagnosis,treatment and prevention of retrostomal internal hernia complicating Billroth Ⅱ subtotal gastrectomy.Methods Fourteen cases of intenal hernia developed out of 2014 cases undergoing Billroth Ⅱ subtotal gastretomy performed from 1975 to 1997 in the author's hospital.The clinical data was retrospectively analyzed.Results Twelve internal hernias developed after antecolonic gastrojejunostomy with the afferent loop of between 16 cm～25 cm.Two developed after retrocolonic gastrojejunostomy with the afferent loop of between 10 cm～14 cm.The mortality rate was 28%(4/14).Conclusions Retrostomal internal hernia complicating Billroth Ⅱ subtotal gastrectomy is highly fatal unless it is diagnosed at the early stage because it is often of strangulated intestinal obstruction.Laparotomy is the only therapy.Close the gap between the anastomotic stoma and the adjacent organs and to select proper lengh of the afferent loop is the key to prevent this severe complication.