Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
World J Surg. 2010 Oct;34(10):2389-92. doi: 10.1007/s00268-010-0602-5.
The incidence of afferent loop obstruction after gastrectomy with Roux-en-Y reconstruction has not yet been reported. The aim of this study was to elucidate the incidence of afferent loop obstruction after distal gastrectomy with Roux-en-Y reconstruction performed through an open approach.
We conducted a retrospective review of the data of 1908 patients who underwent distal gastrectomy followed by Roux-en-Y reconstruction through an open approach between January 1999 and December 2008.
Four patients (0.2%) developed afferent loop obstruction. The median age of the patients, consisting of three men and one woman, was 64 years (range 46-78 years). The cause of the afferent loop obstruction was internal herniation in two patients, adhesion in one patient, and peritoneal recurrence in one patient. The internal herniation occurred at the mesenteric gap in the region of the jejunojejunostomy. The interval between the initial gastrectomies and the emergency operations for afferent loop obstruction ranged from 3 weeks to 2 years (median 5 months). Three of the four patients were symptomatic, with vomiting and abdominal pain. All patients recovered following the emergency operations, and none died of this complication.
Afferent loop obstruction develops rarely after distal gastrectomy with Roux-en-Y reconstruction through an open approach. This rare but fatal complication should be considered when a patient complains of abdominal pain and/or vomiting after distal gastrectomy with Roux-en-Y reconstruction.
胃切除术后 Roux-en-Y 重建后输入襻梗阻的发生率尚未见报道。本研究旨在阐明经剖腹手术行远端胃切除术后 Roux-en-Y 重建后发生输入襻梗阻的发生率。
我们回顾性分析了 1908 例患者的数据，这些患者于 1999 年 1 月至 2008 年 12 月期间经剖腹手术行远端胃切除术后 Roux-en-Y 重建。
4 例（0.2%）发生输入襻梗阻。4 例患者均为男性，中位年龄 64 岁（范围 46-78 岁）。2 例患者的输入襻梗阻原因为内疝，1 例患者为粘连，1 例患者为腹膜复发。内疝发生在空肠空肠吻合口肠系膜间隙。初始胃切除术和输入襻梗阻的急诊手术之间的时间间隔为 3 周至 2 年（中位时间 5 个月）。4 例患者中有 3 例有症状，表现为呕吐和腹痛。所有患者经急诊手术后均恢复，无死亡病例。
经剖腹手术行远端胃切除术后 Roux-en-Y 重建后，输入襻梗阻的发生率较低。当患者在经远端胃切除术后 Roux-en-Y 重建后出现腹痛和/或呕吐时，应考虑这种罕见但致命的并发症。
