胃切除术后Petersen疝九例

Nine cases of Petersen’s hernia after gastrectomy and review of the literature

目的总结胃术后腹内疝(Petersen疝)的病因、临床特征、治疗及预防方法,提高对Petersen疝的认识。方法2018年1月~2021年12月我院接受治疗的胃切除术后Petersen疝病人9例,因原发病行开腹毕-Ⅱ式吻合者7例,Roux-en-Y吻合者2例,发病持续时间中位数为2天,血常规中性粒细胞百分比均有不同程度的增高,并发急性胰腺炎2例,术前腹部CT检查显示吻合口壁增厚、近端小肠梗阻征象4例,小肠扭转征象2例,未见特殊征象仅有小肠梗阻3例,术前均未明确诊断为Petersen疝,所有病人均接受了外科手术治疗,术中见输出段小肠发生扭转并疝入Petersen间隙5例,输出段未发生扭转疝入Petersen间隙3例,输入段小肠发生扭转并疝入Petersen间隙1例,其中,有4例病人因小肠坏死行肠切除、肠吻合术。结果术后1例出现胸腹腔积液,经治疗后均痊愈出院。结论Petersen疝为胃切除术后较为罕见的并发症,术前腹部CT检查有助于对病人病情危重程度进行判断,可作为首选的检查方法,少数病人合并有急性胰腺炎,应注意术前及术后淀粉酶的变化,一旦确诊应进快行手术治疗。

Objective To summarize the etiology,clinical features,treatment and prevention of internal abdominal hernia after gastric surgery(Petersen hernia)and improve the understanding of Petersen hernia.Methods A retrospective analysis in January 2018 to December 2021 jilin university fellowship between China and Japan hospital for treatment of 9 cases after gastrectomy Petersen hernia patients,7 cases underwent open Bie-ⅱanastomosis and 2 cases underwent Roux-en-Y anastomosis due to the primary disease.The median duration of onset was 2 days.The percentage of neutrophils in blood routine was increased to varying degrees.Preoperative abdominal CT showed anastomotic wall thickening,proximal small bowel obstruction sign 4 cases,small intestine torsion signs in 2 cases,no special signs only 3 cases of small intestinal obstruction,has not been in patients with preoperative diagnosis for Petersen hernia,all patients underwent surgical treatment,intraoperative see output section of the small intestine to shift into the Petersen clearance and hernia in 5 cases,There were 3 cases without torsional herniation into Petersen space in the output segment and 1 case with torsional herniation into Petersen space in the input segment.Among them,4 patients underwent intestinal resection and anastomosis due to intestinal necrosis.Results One patient developed pleural and abdominal effusion after operation,and all patients were cured and discharged after treatment.Conclusions Petersen’s hernia is a relatively rare complication after gastrectomy.Preoperative abdominal CT can help to determine the criticality of the patient’s condition and can be the first choice of examination.A small number of patients with acute pancreatitis should pay attention to preoperative and postoperative amylase changes,and once the diagnosis is confirmed,surgery should be performed as soon as possible.