Billroth-Ⅱ术后输入襻梗阻的临床分析  

Postoperative afferent loop obstruction in patients undergoing Billroth-Ⅱsubtotal gastrectomy

作　　者：何博华[1] 杨建新[1] 钱聚标[1] 邱烺[1] 王华[1] 

机构地区：[1]广东药学院外科教研室,广州510224

出　　处：《中华普通外科杂志》2006年第6期443-445,共3页Chinese Journal of General Surgery

摘　　要：目的探讨Billroth-Ⅱ胃大部分切除术后输入襻梗阻的病因、预防、临床表现、诊断和治疗。方法本组共15例输入襻梗阻,对患者的手术史、临床表现、影像学检查进行总结分析。结果典型的不完全性输入襻梗阻表现为上腹胀痛、上腹部可触及肿大的肠襻、恶心、腹部阵发性绞痛,其后喷射性呕吐大量含胆汁的液体,呕吐后症状立刻缓解,肿大的肠襻不能再触及。15例均再次剖腹手术,术中见输入襻不同程度的扩张,7例行Braun吻合术,8例行Roux-en-Y吻合术。本组无术后严重合并症,无围手术期死亡,患者术后均顺利恢复,梗阻症状消失。术后追踪观察3～10年,全部15例的残胃及吻合口均无溃疡,胃镜检查未见胆汁返流。结论严格遵守正确的手术操作常规是预防输入襻梗阻的关键；诊断明确后,应尽早再手术；Braun吻合术、Roux-en-Y吻合术为较理想的术式。Objective To investigate the cause, the clinical manifestations, the diagnosis and treatment of afferent loop obstruction after Billroth-Ⅱ subtotal gastrectomy. Methods Afferent loop obstruction in 15 cases were reported. The symptoms and signs of typical incomplete afferent loop obstruction include distending and colicky pain, palpable intestinal loop in the upper abdomen and nausea followed by bilious projectile vomiting accompanied by disappearance of symptoms and the ansa intestinalis. Laparotomy was performed for all the 15 patients. Improper length of the afferent loop which was formed during the primary surgery leading to kinking and or angulation of the loop was indentified intraoperatively. Braun anastomosis was performed for 7 patients and Roux-en-Y anastomosis for the other 8 patients. Results There was no severe postoperative complications nor perioperative mortality. During the follow-up of 3 to 10 years, gastroscopy found no ulcer nor bile regurgitation. Conclusion Postgastrectomy afferent loop obstruction is preventable should operative protocol is strictly followed. Upon establishment of diagnosis laparotomy should he undertaken. Braun anastomosis or Roux-en-Y anastomosis is usually the remedy of cure.

关 键 词：胃切除术 肠梗阻 

分 类 号：R656.6[医药卫生—外科学] R656.61[医药卫生—临床医学]