胃癌结肠前Roux-en-Y消化道重建术后肠系膜裂孔疝临床特点及诊治方法

CLINICAL FEATURES AND DIAGNOSIS AND TREATMENT OF MESENTERIC HERNIA AFTER ANTECOLIC ROUX-EN-Y GASTRIC BYPASS IN PATIENTS WITH GASTRIC CANCER

目的探讨胃癌病人结肠前Roux-en-Y消化道重建术后肠系膜裂孔疝的临床特点及其诊治方法。方法回顾性分析2010年1月—2017年1月在我院行结肠前Roux-en-Y消化道重建术后发生肠系膜裂孔疝的7例胃癌病人的临床资料。结果 7例病人中,1例初次手术为腹腔镜手术,余6例初次手术为开放手术。所有病人均表现为腹痛,4例出现典型肠梗阻表现。术前腹部CT检查,所有病人均表现为小肠梗阻,其中2例有"漩涡征",1例表现为肠管及系膜增厚。所有病人均行手术治疗,术中4例病人见小肠在上提空肠-横结肠系膜缺损处形成腹内疝,3例病人见小肠在空肠-空肠吻合系膜缺损处形成腹内疝,均行小肠部分切除术,术后均顺利出院。结论肠系膜裂孔疝的临床表现缺乏特异性,其术前诊断在很大程度上依赖于影像学检查,并需结合病人的Roux-en-Y消化道重建病史。该病一经诊断均应行手术治疗。

Objective To investigate the clinical features and diagnosis and treatment of mesenteric hernia after antecolic Roux-en-Y gastric bypass in patients with gastric cancer.Methods The clinical data of 7 gastric cancer patients with mesenteric herniation after antecolic Roux-en-Y gastric bypass in our hospital from January 2010 to January 2017 were retrospectively analyzed.Results Of the 7 patients,1 had laparoscopic surgery in the primary operation,and 6 had open surgery in the primary operation.All patients showed abdominal pain,and 4 cases had typical intestinal obstruction.Preoperative abdominal CT findings showed that all patients had small bowel obstruction,including 2 cases of＂swirl sign＂and 1 case of intestinal and mesenteric thickening.All patients underwent surgical treatment;during the operation,the small intestine was found to form an intra-abdominal hernia at the mesenteric defect of the superior jejunum-transverse colon in 4 patients and at the mesenteric defect of the jejuno-jejunal anastomosis in 3 patients;all these patients underwent partial resection of the small intestine and were discharged after surgery.Conclusion The clinical manifestations of mesenteric hernia are not specific.The preoperative diagnosis depends largely on the imaging examination and needs to be combined with patients＇ history of Roux-en-Y gastrointestinal reconstruction.Once diagnosed,surgery should be performed.