Channer L T, Squires G T, Price P D
Department of Surgery, Mount Carmel Health System, Columbus, Ohio, USA.
JSLS. 2000 Jul-Sep;4(3):225-30.
Acute and chronic gastric volvulus usually present with different symptoms and affect patients primarily after the fourth decade of life. Volvulus can be diagnosed by an upper gastrointestinal contrast study or by esophagogastroduodenoscopy. There are three types of gastric volvulus: 1) organoaxial (most common type); 2) mesenteroaxial; and 3) a combination of the two. If undetected or if a delay in diagnosis and treatment occurs, serious complications can develop.
We present four cases of surgical repair of organoaxial volvulus consisting of laparoscopic reduction of the volvulus with excision of the hernia sac and reapproximation of the diaphragmatic crura. A Nissen fundoplication, to prevent reflux, was performed, and the stomach was pexed to the anterior abdominal wall by laparoscopic placement of a gastrostomy tube, thus preventing recurrent volvulus.
There were no operative complications, and all four patients tolerated the procedure well. The patients were discharged one to three days postoperatively and were asymptomatic within two months.
With the advancement of laparoscopic Nissen fundoplication and laparoscopic repair of paraesophageal and hiatal hernias, minimally invasive surgical repair is possible. Based on our experience, we advocate the laparoscopic technique to repair gastric volvulus.
急性和慢性胃扭转通常表现出不同症状，主要影响40岁以后的患者。胃扭转可通过上消化道造影检查或食管胃十二指肠镜检查来诊断。胃扭转有三种类型：1）器官轴型（最常见类型）；2）系膜轴型；3）两者混合型。如果未被发现或诊断及治疗出现延误，可能会引发严重并发症。
我们呈现了4例器官轴型胃扭转的手术修复病例，包括通过腹腔镜将扭转复位、切除疝囊并重新缝合膈脚。为防止反流，进行了nissen胃底折叠术，并通过腹腔镜放置胃造瘘管将胃固定于前腹壁，从而预防复发性胃扭转。
无手术并发症，所有4例患者对手术耐受良好。患者术后1至3天出院，两个月内均无症状。
随着腹腔镜nissen胃底折叠术以及腹腔镜修复食管旁疝和食管裂孔疝技术的发展，微创外科修复成为可能。基于我们的经验，我们提倡采用腹腔镜技术修复胃扭转。
