胃癌术后腹内疝形成原因及临床诊治分析

Postoperative internal hernia of gastric cancer：analysis of formation reasons and clinical diagnosis and treatment

目的探讨胃癌术后腹内疝形成原因及临床诊治过程，提高胃癌术后急腹症的诊治水平。方法回顾性分析2013年1月至2016年8月苏州大学附属第一医院普外科收治的7例胃癌术后腹内疝患者的临床诊治资料。结果7例患者中2例为全胃根治性切除术后，3例行远端胃根治性切除术后，2例行近端胃癌根治性切除术后，术前均存在小肠梗阻表现。其中1例患者于术前明确为腹内疝，3例患者术前诊断考虑肠扭转，2例患者术前诊断考虑消化道穿孔，1例患者术前诊断考虑胃瘫。7例患者均于术中证实为胃癌术后腹内疝形成，行腹内疝复位术，术后恢复顺利，无并发症发生。结论随着胃癌腹腔镜手术比例的增多，胃癌术后腹内疝的发生比例有所增加。胃癌术后腹内疝术前诊断困难，表现为小肠梗阻症状，临床中对于腹痛不能缓解的胃癌术后急腹症患者及时行剖腹探查术，有助于减少严重并发症，改善患者预后。

ObjectiveTo explore the reasons and clinical treatment process of postoperative internal hernia in cases of gastric cancer, and improve the diagnosis and treatment level postoperative acute abdomen pain of gastric cancer patients.MethodsA retrospective analysis was carried out to study the data of clinical diagnosis and treatment in 7 patients, who were performed an emergency operation within the First Affiliated Hospital of Soochow University from January, 2013 to August, 2016 caused by postoperative internal hernias of gastric cancer.ResultsAmong the 7 postoperative gastric cancer patients, 2 cases had taken surgery of radical full gastric resection, 3 cases had taken surgery of radical distal gastric resection, and 2 cases had taken surgery of radical proximal gastric resection. All the 7 cases were confirmed to be incarcerated intestinal obstruction caused by internal hernia during emergency operation. Only 1 case was diagnosed to be internal hernia before surgery, while 3 cases were diagnosed as volvulus, 2 cases were diagnosed as perforation and 1 case was diagnosed as gastrolplegia. The small intestinal obstruction of all cases was caused by incarcerated intestinal. All the patients recovered well, and no complications occurred.ConclusionsInternal hernias of the postoperative gastric cancer patients, which is often characterized by small intestinal obstruction symptoms, is difficult to diagnose before operation. Emergency operation in time for the postoperative gastric cancer patients with continuous acute abdominal pain may help to reduce the severe complications and improve patient′s prognosis.