胃癌Roux-en-Y吻合术后Roux襻与Y臂间隙疝12例诊治分析

Diagnosis and treatment of Roux and Y space hernia after Roux-en-Y gastric bypass surgery for gastric cancer patients:a clinical analysis of 12 cases

回顾分析2010年6月至2018年12月绍兴嵊州市人民医院普外科手术确诊的12例Roux襻与Y臂间隙疝患者的临床诊治资料.12例均以腹痛、腹胀,肛门停止排气、排便为主要临床表现,CT扫描主要表现为肠系膜扭转、肠梗阻伴腹水.术中见12例患者肠管均疝人Roux襻与Y臂间隙,4例因肠坏死行肠管切除吻合术.术后1例(行肠管切除吻合术)死亡,1例(行肠管切除吻合术)术后1个月因电解质紊乱死亡;10例术后3个月随访均未再发生Roux襻与Y臂间隙疝.Roux襻与Y臂间隙疝是腹内疝的一种,CT表现一般以肠系膜扭转和肠梗阻为主,对其诊断有一定的价值;诊断后应尽早手术治疗.

Clinical data of 12 patients with gastric cancer,in whom the Roux and Y space hernia developed after gastrectomy with Roux-en-Y anastomosis in our hospital from June 2010 to December 2018,were retrospectively analyzed.The clinical symptoms of patients were abdominal pain,distension and ileus.The main CT findings were torsion of mesentery with whirlpool sign,intestinal obstruction and exudants around the small bowels.During the operation it was found that small bowels herniated into the Roux and Y space in all 12 patients,the necrotic small intestines were resected in 4 patients.Ten patients were recovered,and 2 died.No recurrence was observed in all 10 patients during 3 month-follow up.The postoperative Roux and Y space hernia is a internal hernia and difficult to be diagnosed.The CT scan is valuable for diagnosis of Roux and Y space hernia;the main CT signs were swirled appearance of mesentery and small bowel obstruction.Once diagnosis is made the emergency operation is necessary.