胃切除术后腹内疝15例临床剖析.docVIP

胃切除术后腹内疝15例临床剖析 　　【摘要】 目的 探讨胃切除术后腹内疝发生的相关因素，以期降低发病率和病死率。方法 回顾性分析了15例胃切除术后腹内疝患者的临床资料。结果 9例有诱因，发病时间为胃切除术后2个月～20年。突发腹痛、腹胀并逐渐加剧，向腰背部放射痛是内疝的典型临床表现。术前明确诊断仅2例。本组均行手术治疗，9例不同程度肠坏死，病死率为13.33%。结论 腹内疝是一种严重并发症，一旦出现肠梗阻临床表现应高度怀疑本病。早期手术有助于降低病死率、致残率。胃切除术后应建立良好的饮食习惯，避免餐后剧烈活动。 　　【关键词】 胃切除术； 不良反应； 内疝； 病因学 　　A clinical analysis of 15 cases of postoperative internal abdominal hernia developed after gastrectomy TAN Zhen-dong，ZHUANG Yi.Changzhou Wujin Peoples Hospital, Changzhou 213002, China 　　【Abstract】 Objective To explore the causes and prevention of postoperative internal abdominal hernia developed after total or subtotal gastrectomy.Methods The clinical data of 15 cases of internal abdominal hernia developed after tatal or subtotal gastrectomy are analyzed retospectively.Results 9 cases were found to show predisposing causes, the intervals between the initial gastrectomies and the emergency operations ranging from 2 months to 20 years. The chief clinical manifestation included sudden abdominal pain and distension which aggravated gradually and radiated to the back. Only 2 cases were diagnosed. All cases were treated by operation, and in 9 cases vary degree of intestine necrosis occurred. The postoperative mortality rate was 13.33%.Conclusion Internal abdominal hernia is a serious complication of gastrectomy, which should be highly suspected when symptoms of intestinal obstruction present. Laparotomy as soon as possible is helpful to decrease mortality and extention of intestinal resection. For those who have undergone gastrectomies, a good dietary habbit should be developed and intense movement immediately after meals avoided. 　　【Key words】 Gastrectomy; Adverse reactions; Internal hernia; Etiology 　　胃切除术后发生腹内疝临床上并不少见，但其发病急，病情变化快，易导致肠扭转、肠坏死，后果严重。本文回顾了本院2002年1月～2010年12月共15例胃切除术后腹内疝患者的临床资料，总结分析如下。 　　1 资料与方法 　　1.1 一般资料 本组男11例，女4例，年龄43～74岁（平均60岁）。胃溃疡2例，胃癌13例。胃切除术式2例为远端胃大部切除术，BillrothⅡ式艾氏法吻合；2例为根治性远端胃大部切除术，BillrothⅠ式吻合；1例为根治性近端胃大部切除术，BillrothⅠ式吻合；其余10例均为全胃切除术，消化道Roux-en-Y重建。内疝发病时间