胃癌根治术后内疝七例临床分析

Management of internal hernia after radical gastrectomy for gastric cancer

回顾分析2015年9月至2017年8月期间在浙江省肿瘤医院行胃癌根治术后发生内疝且经手术治疗确诊患者的临床资料,包括患者一般情况、胃癌根治术消化道重建方式,临床症状、影像学表现、治疗方法和预后.共1789例患者接受胃癌根治术,7例患者发生内疝并接受手术治疗,其中Petersen疝4例,小肠系膜裂孔疝2例,膈疝1例.患者均出现典型的机械性肠梗阻症状(双漩涡征);影像学检查可见有肠系膜血管骑跨征以及双漩涡征;6例手术治疗后痊愈,1例由于小肠广泛梗死而放弃治疗.提示胃癌根治术后腹腔内形成异常通道,可能导致内疝形成;肠系膜血管骑跨征,双漩涡征是胃癌根治术后内疝独特的影像学表现;关闭异常通道可预防内疝的发生.

A total of 1789 patients with gastric cancer underwent radical gastrectomy in our hospital from September 2015 to August 2017,internal hernia(IH)developed in 7 cases with a incidence rate of 0.4%.The general condition,the symptoms,imaging findings,treatment methods and prognosis as well as the types of digestive tract reconstruction of patients were retrospective analyzed.There were 4 cases of Petersen's hernia,2 cases of jejuno-jejuno mesenteric hernia and 1 case of diaphragm hernia.All patients developed mechanical obstruction.Imaging examination showed mesenteric vessels overriding sign and double whirl sign.Six patients recovered smoothly,1 patient gave up treatment due to extensive small bowel infarction.It is indicated that the formation of abnormal channels in the abdominal cavity after radical gastrectomy may lead to IH.The mesenteric vessels overriding sign and the double whirl sign are the unique imaging findings of IH after radical gastrectomy.Closing the abnormal channel can prevent the occurrence of IH after gastrectomy.