Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer
Characteristics of internal hernia after gastrectomy with Roux-en-Y reconstruction for gastric cancer
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DOI：
10.1007/s00464-013-3384-7
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发表时间：
2014-06-01
影响因子：
3.1
通讯作者：
Eto, Syohei
中科院分区：
文献类型：
--
作者：
Yoshikawa, Kozo;Shimada, Mitsuo;Eto, Syohei
虽然腹内疝一直是减肥外科领域的一个巨大课题，但在胃癌中的报道很少。为分析胃癌术后内疝的发生率、临床特点及预防措施，对我院12例胃癌术后内疝手术治疗患者进行分析。特征，包括发病率，症状和体征，进行了详细的调查。手术前胃切除术的开放式远端胃切除术的3例患者，开放式全胃切除术的3例患者，腹腔镜辅助远端胃切除术的2例患者，腹腔镜全胃切除术的4例患者。最常见的内疝部位是空肠空肠吻合肠系膜缺损（5例）和Petersen缺损（5例），横结肠肠系膜（1例）和食管裂孔（1例）。开放式和腹腔镜胃切除术前无显著差异。肠系膜缺损闭合后，没有进一步的内部疝发生。CT检查中，10例患者在3D图像上出现漩涡征，提示早期识别和治疗内疝的重要性，以及通过闭合肠系膜缺损预防内疝的重要性。
Although the internal hernias have been a huge topic in the field of bariatric surgery, there were a few reports in gastric cancer. The purpose of this study was to analyze the incidence, clinical features, and prevention of internal hernia after gastrectomy for gastric cancer.Twelve patients who underwent surgical treatment for internal hernia in our hospital after gastrectomy were analyzed. Features, including incidence, symptoms, and signs, were investigated in detail.The operative procedures for preceding gastrectomies were open distal gastrectomy in three patients, open total gastrectomy in three patients, laparoscopic-assisted distal gastrectomy in two patients, and laparoscopic total gastrectomy in four patients. The most frequent sites of internal hernias were jejunojejunostomy mesenteric defects (five patients) and Petersen's defect (five patients), mesenterium of transverse colon (one patient), and esophagus hiatus (one patient). There was no significant difference between open and laparoscopic preceding gastrectomies. After closure of the mesenteric defect was introduced, no further internal hernias occurred. On CT examination, the whirl sign was present in ten patients on 3D images.The present data suggest the importance of early recognition and treatment of internal hernia, as well as its prevention by closure of mesenteric defects.