摘要
目的探讨胃癌切除术后Petersen疝的临床特征。方法回顾性分析2013年1月至2020年4月于绵阳市中心医院接受治疗的10例胃癌切除术后Petersen疝患者的临床资料,总结其临床特征。结果患者均为男性,均以腹部疼痛为主要临床表现,入院前腹痛症状持续1 h到2个月不等,中位时间4.5 d,其中腹痛程度较剧烈6例,腹痛间断性反复发作4例。合并恶心、呕吐、腹胀等肠梗阻症状8例。所有患者均有不同程度的腹部压痛,其中伴腹部压痛、反跳痛及腹肌紧张的腹膜炎体征1例。胃癌切除术后,所有患者体质量指数(BMI)均下降2.3~5.1 kg·m^(-2),中位数3.5 kg·m^(-2);白细胞及C反应蛋白均升高。腹部CT结果显示,肠系膜扭转伴有小肠梗阻征象6例,腹内疝伴小肠梗阻征象2例,肠系膜扭转未合并肠梗阻2例。术前CT提示肠系膜上静脉回流受阻征象4例。术前10例患者均未明确诊断为Petersen疝,其中诊断为肠系膜扭转伴小肠梗阻6例,诊断为腹内疝伴小肠梗阻2例,诊断为肠系膜扭转2例。所有患者均接受手术治疗,其中9例接受腹内疝复位、Petersen孔缝合关闭,1例因合并肠坏死接受腹内疝复位、肠切除肠吻合、Petersen孔缝合关闭术,术后均痊愈出院。结论胃癌切除术后Petersen疝患者的病程长短不一,临床表现轻重不一,缺乏特异性。Petersen疝好发于男性,常伴有胃癌术后BMI下降,肠梗阻为其主要临床表现,常合并肠缺血、肠坏死。术前诊断较困难,易延误诊治,腹部CT可作为首选检查方法。若腹部CT检查提示腹内疝或肠系膜扭转伴小肠梗阻,则高度怀疑Petersen疝。早期明确诊断并及时进行外科手术是治疗成功的关键,可提高患者的救治成功率,但重点在于预防。
Objective To explore the clinical features of petersen’s hernia after gastric cancer resection.Methods The clinical data of 10 patients with Petersen’s hernia after gastric cancer resection in Mianyang Central Hospital from January 2013 to April 2020 were retrospectively analyzed.Results All the 10 patients were male,all of them had the clinical manifestation of abdominal pain.Before admission,abdominal pain lasted from 1 hour to 2 months,with a median time of 4.5 days.Among them,there were 6 cases with severe abdominal pain and 4 cases with intermittent recurrent abdominal pain.There were 8 patients complicated with nausea,vomiting,abdominal distension and other intestinal obstruction symptoms.All the patients had different degrees of abdominal tenderness,and one patient had signs of peritonitis with abdominal tenderness,rebound pain and muscle tension.The BMI of 10 patients after gastrectomy decreased ranged from 2.3 to 5.1 kg·m^(-2),with a median of 3.5 kg·m^(-2).The white blood cells and C-reactive protein of 10 patients were increased.The abdominal CT examination showed that there were 6 patients with mesenteric torsion and small intestinal obstruction,there were 2 patients with intra-abdominal hernia and small intestinal obstruction,and there were 2 patients showed mesenteric torsion without small intestinal obstruction.Among the 10 patients,there were 4 cases with preoperative CT findings of superior mesenteric vein reflux obstruction signs.All patients were not diagnosed as Petersen’s hernia before gastric cancer resection.Among them 6 patients were diagnosed as mesenteric torsion with small intestinal obstruction,and 2 patients were diagnosed as intra-abdominal hernia with small intestinal obstruction,and 2 patients were diagnosed as mesenteric torsion.There were 9 cases accepted internal hernia reduction and Petersen’s hole closure,and 1 case accepted internal hernia reduction,enterostomy and Petersen’s hole closure.All recovered and were discharged from hospital.Conclusion The course of disease of patients with Petersen’s hernia after gastric cancer resection is different,the clinical manifestations are different and lack of specificity.The disease occurs in males,and accompanied by the reduction of BMI.Intestinal obstruction is the main clinical manifestation of Petersen hernia,often combined with intestinal ischemia and necrosis.The diagnosis of Petersen’s hernia is difficult,and it is easy to delay the diagnosis and treatment of the disease.Abdominal CT can be used as the preferred method.Petersen hernia can be highly suspected when abdominal CT examination showed abdominal hernia or mesenteric torsion with small intestinal obstruction.Early diagnosis and timely surgical operation can increase the success rate of treatment,but the prevention is the most important.
作者
柳万忠
LIU Wanzhong(Department of General Surgery,Mianyang Central Hospital,Mianyang 621000,China)
出处
《河南医学研究》
CAS
2021年第20期3698-3702,共5页
Henan Medical Research
