全胃切除术后远期继发急性肠扭转17例诊治分析

目的: 探讨全胃切除术后远期继发急性肠扭转的临床特点及诊治原则。方法: 全胃切除术后远期继发急性肠扭转17例均行诊断性腹腔穿刺和64排螺旋CT腹部平扫:手术治疗16例,其中5例行肠粘连松解+肠扭转复位,7例行肠扭转复位+肠减压,4例行肠扭转复位+坏死肠段切除+端端吻合;1例保守治疗。结果: 17例中16例术后均康复出院,随访1～2年均无复发,1例因未能及时手术,导致大面积肠坏死伴中毒性休克,死于多脏器功能衰竭。结论: 全胃切除术后远期继发急性肠扭转以手术治疗为主,保守治疗需要严密观察腹部症状和体征,并及时复查腹部螺旋CT。

Clinical analysis of the acute volvulus after total gastrectomy in 17 cases

Objective: To investigate the clinical characteristics and principles of diagnosis and treatment of acute volvulus after total gastrectomy.Methods: Seventeen cases with acute volvulus after total gastrectomy were treated with abdominal puncture and 64 row helical CT scan.Among 16 cases treatment with operation,5 cases were treated with intestinal adhesion release combined with volvulus reduction,7 cases were treated with volvulus reduction combined with enteral decompression and 4 cases were treated with volvulus reduction,necrotic bowel resection combined with end to end anastomosis.One case was treated with conservative method.Results: Sixteen patients treated with operation discharged,and were followed up 1 to 2 years.One patient failed to timely operation,which led to massive intestinal necrosis complicated with toxic shock,multiple organ failure and die.Conclusions: Surgical treatment was the main method to treat acute volvulus after total gastrectomy.The abdominal symptoms and signs and abdominal CT should be closely observed during the course of conservative treatment.