胃癌术后Petersen疝六例诊治分析  

Diagnosis and treatment of Petersen hernia after gastrectomy:report of 6 cases

作　　者：曹键[1] 叶颖江[1] 寺岛雅典 Cao Jian;Ye Yingjiang;Terashima Masanori(Department of Gastroenterological Surgery,Peking University People′s Hospital,Beijing 100044,China;Division of Gastric Surgery,Shizuoka Cancer Center,Shizuoka 4118777,Japan)

机构地区：[1]北京大学人民医院胃肠外科,100044 [2]日本静冈癌症中心胃外科,4118777

出　　处：《中华普通外科杂志》2020年第11期870-873,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金(51971062);日中笹川医学奖学金。

摘　　要：目的总结胃癌术后发生Petersen疝患者的诊断及处理方法。方法对静冈癌症中心2014年1月至2019年12月期间诊断Petersen疝并行手术治疗的6例胃癌患者进行回顾性分析。结果6例患者均为男性,中位发病年龄76岁,2例曾行机器人辅助全胃切除术,2例曾行腹腔镜远端胃切除术,2例曾行腹腔镜近端胃切除术。初次胃癌手术时均已关闭Petersen间隙。症状在术后1~55个月出现,上腹痛伴恶心、呕吐为最常见的临床表现。6例腹部CT检查表现为小肠扩张,肠梗阻样改变;3例CT呈漩涡征改变。6例患者均手术探查未见肠坏死并再次缝合Petersen间隙,术后顺利出院,随访至今未见再发。结论Petersen疝是胃术后的一种罕见并发症。应根据临床病史和体格检查结果,尽早进行腹部CT并积极手术治疗。Objective To explore the clinical characteristics,diagnosis and treatment of Petersen hernia after gastrectomy.Methods The clinical data of 6 patients with Petersen hernia developed after gastrectomy in Shizuoka Cancer Center from Jan 2014 to Dec 2019 were retrospectively analyzed.Results All 6 patients were males,with a median age of 76 years.The operative procedures for preceding gastrectomies were robotic-assisted total gastrectomy in 2 patients,laparoscopic distal gastrectomy in 2 patients,and laparoscopic proximal gastrectomy in 2 patients.Petersen′s defect was closed in all patients at previous gastrectomy.The time of onset was 1 month to 55 months after surgery.The main manifestations are acute pain in upper abdomen with nausea and vomiting.In all the cases,abdominal CT showed obstruction caused dilatation of the small intestine.The whirl sign was present in 3 patients.All the patients underwent reoperation with reduction and repair of the hernia.All the patients did not show obvious bowel necrosis.Their postoperative courses were uneventful,and all the patients were discharged.During the follow-up period,none of the patients developed complications related to the Petersen hernia.Conclusions Petersen hernia is a rare complication of gastrectomy.It is important to conduct abdominal CT scanning as early as possible from the clinical history and physical findings,and to determine the surgical indication.

关 键 词：胃肿瘤 外科手术 并发症 Petersen疝 

分 类 号：R735.2[医药卫生—肿瘤]