Ojima Toshiyasu, Nakamori Mikihito, Nakamura Masaki, Katsuda Masahiro, Hayata Keiji, Kato Tomoya, Tsuji Toshiaki, Yamaue Hiroki
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
Surg Laparosc Endosc Percutan Tech. 2017 Dec;27(6):470-473. doi: 10.1097/SLE.0000000000000481.
The aim of this study was to clarify internal hernia (IH) characteristics after laparoscopic gastrectomy.
This was a retrospective study of 1943 consecutive gastric cancer patients who underwent surgery at our institute between 2004 and 2015. Since 2013, our technique includes antecolic Roux-en-Y (RY) with closure of all mesenteric defects during laparoscopic total gastrectomy (LTG) as standard.
Postoperative IH was only detected in patients who underwent total gastrectomy with RY reconstruction. Furthermore, the incidence of IH was significantly higher after LTG than after open total gastrectomy (4.9% vs. 1.0%; P=0.005). IH after LTG occurred in 8.0% of patients before standardization with closure of the mesenteric defects, but no IH was observed after standardization (P=0.047).
Closure of all mesenteric defects is recommended for gastric cancer patients who undergo LTG with antecolic RY. Registration number: UMIN000009163/000025029 (www.umin.ac.jp/ctr/).
本研究旨在阐明腹腔镜胃切除术后内疝（IH）的特征。
这是一项对2004年至2015年间在我院连续接受手术的1943例胃癌患者的回顾性研究。自2013年起，我们的技术标准包括在腹腔镜全胃切除术（LTG）期间行结肠前 Roux-en-Y（RY）吻合并封闭所有肠系膜缺损。
术后内疝仅在接受RY重建全胃切除术的患者中被检测到。此外，LTG术后内疝的发生率显著高于开放全胃切除术后（4.9%对1.0%；P = 0.005）。在肠系膜缺损封闭标准化之前，LTG术后8.0%的患者发生内疝，但标准化后未观察到内疝（P = 0.047）。
对于接受结肠前RY吻合的LTG胃癌患者，建议封闭所有肠系膜缺损。注册号：UMIN000009163/000025029（www.umin.ac.jp/ctr/）。
