摘要
目的探讨胃癌根治术后Petersen疝病例的临床特征、治疗及预后情况,以提高临床医师对该病的认识。方法对华中科技大学同济医学院附属协和医院和浠水县人民医院2018年1月至2023年10月诊治的6例胃癌根治术后Petersen疝、2013年1月至2023年6月间国内文献报道的75例胃癌根治术后Petersen疝病例进行汇总分析。结果81例病人中男性77例,女性4例;年龄35~90岁,中位年龄56岁;其中行全胃切除术32例,行远端胃切除术46例,行近端胃切除术3例。发生Petersen疝距既往胃手术时间间隔为7 d~30年,中位间隔时间10个月。其中伴有腹部疼痛79例,腹胀66例,恶心、呕吐43例,肛门停止排气排便31例。术前腹部CT检查中79例病人出现肠梗阻表现,2例未合并肠梗阻。二次手术时行机器人手术者2例,腹腔镜手术19例,开放手术60例。56例未行肠切除手术,25例切除小肠后行内疝复位。81例中1例病人出现围手术期死亡,其余病人均顺利出院,术后住院时间为5~21 d。结论Petersen疝是胃癌根治术后一种较为罕见的并发症,对于胃癌根治术后出现肠梗阻的病人应当警惕腹内疝的发生,CT明确后应积极手术探查。
Objective To explore the clinical characteristics,treatment,and prognosis of Petersen hernia after radical gastrectomy for gastric cancer,thus enhancing the understanding of clinical physicians about this disease.Methods A summary analysis was conducted on 6 cases of Petersen hernia after radical gastrectomy treated by Union Hospital,Tongji Medical College,Huazhong University of Science and Technology and Xishui People's Hospital from January 2018 to October 2023,as well as 75 cases of Petersen hernia reported in domestic literatures from January 2013 to June 2023.Results Among the 81 patients,there were 77 males and 4 females,aged 35-90 years(median age 56 years).Among them,32 underwent total gastrectomy,46 underwent distal gastrectomy,and 3 underwent proximal gastrectomy.The interval between Petersen hernia and previous gastric surgery ranged from 7 days to 30 years,with a median interval of 10 months.A total of 79 cases were accompanied by abdominal pain,66 cases were accompanied by abdominal distension,43 cases were accompanied by nausea and vomiting,and 31 cases were accompanied by anal cessation of exhaust and defecation.Among the preoperative abdominal CT scans,79 patients showed signs of intestinal obstruction,and 2 patients were not complicated with intestinal obstruction.During the second surgery,2 patients underwent robotic surgery,19 patients underwent laparoscopic surgery,and 60 patients underwent open surgery.Totally,56 cases did not undergo intestinal resection surgery,while 25 cases underwent internal hernia reduction after removing the small intestine.Among the 81 cases,one patient died during the perioperative period,while the others were discharged after a success treatment.The postoperative hospitalization time ranged from 5days to 21 days.Conclusion Petersen hernia is a relatively rare complication after radical gastrectomy for gastric cancer.Patients with intestinal obstruction after radical gastrectomy for gastric cancer should be vigilant about the occurrence of intra-abdominal hernia,and active surgical exploration should be performed after CT diagnosis to improve the prognosis.
作者
沈乾
南政
毛淦
陈志亮
田红坤
杜雨强
蒋祈
陶凯雄
张鹏
Shen Qian;Nan Zheng;Mao Gan;Chen Zhiliang;Tian Hongkun;Du Yuqiang;Jiang Qi;Tao Kaixiong;Zhang Peng(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430022,China;Department of Gastrointestinal Surgery,Xishui People's Hospital,Hubei Xishui 438200,China)
出处
《腹部外科》
2025年第3期224-228,共5页
Journal of Abdominal Surgery
基金
国家自然科学基金(81702386,82072736,82373123)
湖北省自然科学基金面上项目(2021CFB566)
白求恩·肿瘤基础研究计划(BCF-NH-ZL-20201119-002)。
关键词
Petersen疝
并发症
胃癌术后
腹内疝
Petersen hernia
Complications
Postoperative gastric cancer
Internal hernia
