11例毕Ⅱ式胃肠吻合术后发生Petersen疝患者的临床特点及诊疗方案探讨  

Investigate of clinical characteristics and diagnosis and treatment of 11 patients with Petersen hernia after Billroth II gastrointestinal anastomosis

作　　者：王勃 李芳芳 崔仁杰 陈志广 韩云英 杨爱福 李金科 WANG Bo;LI Fangfang;CUI Renjie;CHEN Zhiguang;HAN Yunying;YANG Aifu;LI Jinke(Department of General Surgey,the First People's Hospital of Longnan,Longnan,Gansu 746000,China)

机构地区：[1]陇南市第一人民医院普外科,甘肃陇南746000

出　　处：《医药前沿》2025年第11期53-57,共5页Journal of Frontiers of Medicine

基　　金：陇南市市级社会化出资科技计划项目社科项目(2022-S•SZ-10)。

摘　　要：目的探讨11例毕Ⅱ式胃肠吻合术后发生Petersen疝患者的临床特点及诊疗方案。方法回顾性分析2016年3月—2022年10月陇南市第一人民医院收治的11例毕Ⅱ式胃肠吻合术后Peterson疝患者的临床资料。结果11例患者中男10例,女1例;年龄38~65岁,中位年龄51岁;本次发病时间与手术时间间隔为35 d~36个月,平均22.5个月。患者均以腹部胀痛进行性加剧伴恶心、呕吐及呕吐后腹痛不缓解为主要临床表现,均有肠梗阻表现;腹部立位X线检查均提示存在不同程度的空回肠肠管扩张,可见多处散在气液平面;CT检查提示有小肠梗阻和肠系膜扭转。11例患者均接受急诊开腹手术,其中8例患者行Peterson疝复位+腹内疝孔修补术,3例患者在复位修补的基础上,还接受了坏死肠管的切除和吻合。11例患者术后住院时间7~15 d,平均(9.3±1.6)d;术后胃肠功能恢复时间18~40 h,平均(20.4±6.2)h,术后恢复良好,随访1年均未复发,也未再次梗阻。结论毕Ⅱ式胃肠吻合术后Peterson疝的临床表现和诊断均缺乏特异性,一旦患者出现肠梗阻症状,临床医生需完善腹部CT检查,并结合临床经验迅速做出判断,一经确诊应立即手术,以最大限度减轻其对患者机体的损害。Objective To investigate the clinical characteristics and diagnosis and treatment of 11 patients with Petersen hernia after Billroth II gastrointestinal anastomosis.Methods The clinical data of 11 patients with Peterson hernia after Billroth II gastrointestinal anastomosis admitted to the First People's Hospital of Longnan from March 2016 to October 2022 were retrospectively analyzed.Results There were 10 males and 1 female in 11 patients.The age ranged from 38 to 65 years old,with a median age of 51 years old.The interval between the onset time and the operation time was 35 days to 36 months,with an average of 22.5 months.The main clinical manifestations of all patients were progressive abdominal pain with nausea,vomiting and no relief of abdominal pain after vomiting,and all of them had intestinal obstruction.Abdominal standing X-ray examination showed that there were different degrees of jejunoileum intestinal dilatation,and multiple scattered gas-liquid planes could be seen.CT examination showed small bowel obstruction and mesenteric torsion.All the 11 patients underwent emergency laparotomy,of which 8 patients underwent Peterson hernia reduction+intra-abdominal hernia repair,and 3 patients underwent resection and anastomosis of necrotic bowel on the basis of reduction and repair.The postoperative hospital stay of 11 patients was 7-15 days,with an average of(9.3±1.6)days.The postoperative recovery time of gastrointestinal function was 18-40 h,with an average of(20.4±6.2)h.The postoperative recovery was good,and there was no recurrence or re-obstruction during the 1 year follow-up.Conclusions The clinical manifestations and diagnosis of Peterson hernia after Billroth II gastrointestinal anastomosis are lack of specificity.Once the patient has symptoms of intestinal obstruction,clinicians need to improve abdominal CT examination and make a quick judgment based on clinical experience.Once diagnosed,surgery should be performed immediately to minimize the damage to the patient's body.

关 键 词：毕Ⅱ式胃肠吻合术 腹内疝 Petersen疝 肠梗阻 腹部立位X线 

分 类 号：R573[医药卫生—消化系统]