胃次全切除、胃空肠吻合术后腹内疝发生因素及其预防的探讨

目的：探讨腹内疝的发生因素，以期预防及降低病死率。方法：回顾性分析34例腹内疝患者的临床资料。结果：34例均发生在Billroth-II式术后（Eiselsberg术后26例及Moynihan吻合术后8例）。发病时间为术后1个月内至21年，1年以内发病者28例（82.4%）。突发上腹部疼痛伴腰背放射痛是其主要表现。本组术前误诊率为82.3%。全组均经手术治疗，病死率为29.4%。结论：腹内疝是一种严重并发症。Billroth-II术后凡出现肠梗阻临床表现的患者均应考虑此病，早期手术是降低其病死率的关键。

Study on the factors involved in the occurrence of internal abdominal hernia after subtotal gastrectomy and gastrojejunostomy and their prevention

Objective To study the factors involved in the development of internal abdominal hernia after subtotal gastrectomy and gastrojejunostomy(Billroth II gastrectomy), and the means for their prevention and for decrease of mortality rate.Methods The clinical datas of 34 cases of internal abdominal hernia occurred after gastrectomy were analyzed retrospectively. Results All of the 34 cases of internal abdominal hernia developed after Billroth-II operation(26 cases after Eiselsberg operation and 8 cases after Moynihan anastomosis). The time of onset was from 1 month to 21 years after operation, and in 28 cases was during the first year after operation(82.4%).The chief complaint was sudden epigastric pain with radiation of pain to the back. The preoperative misdiagnostic rate was 82.3%. All cases were treated by operation. The postoperative mortality rate was 29.4%.Conclusions Internal abdominal hernia is a serious complication of Billroth-II operation. Patients who present with symptoms of intestinal obstruction after Billroth-II operation should be considered to have internal abdominal hernia.The only key to decrease mortality rate is operative treatment as soon as possible.