Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).
Pancreatic Disease Center, Department of General Surgery, Rui Jin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland).
Med Sci Monit. 2018 Apr 16;24:2287-2293. doi: 10.12659/msm.909273.
BACKGROUND Robotic assisted pancreaticoduodenectomy (RPD) is reported to be safe and feasible. Internal hernia (IH) after RPD is a serious but rarely reported complication. MATERIAL AND METHODS We retrospectively reviewed data of 231 patients who underwent RPD from October 2010 to December 2016. The incidence, symptoms, time of presentation, and outcome were investigated. RESULTS Five patients (2.6%) were diagnosed with IH. Significant correlation (P<0.001) between IH and transverse mesocolon defect was confirmed. In patients without defect closure, the incidence of IH was 62.5%, while patients who received defect closure experienced no IH. The median time between initial surgery and occurrence of IH was 76 days. The main symptoms were abdominal pain, nausea, and vomiting. All patients received abdominal computed tomography (CT) and were suspected to have IH according to imaging and symptoms. All patients underwent reoperation (2 laparoscopic and 3 open surgery). The median length of hospital stay was 13 days. No patient experienced a relapse after treatment. CONCLUSIONS Abdominal pain, nausea, and vomiting were common symptoms in our study patients who underwent RPD. IH should be suspected if there is a positive finding on CT. Timely reoperation is necaAbdominal pain, nausea, and vomiting were common symptoms in our study patients who underwent RPD. IH should be suspected if there is a positive finding on CT. Timely reoperation is necessary because IH may cause intestinal ischemia. Meticulous closure of the mesenteric defect is vital to avoid IH.essary because IH may cause intestinal ischemia. Meticulous closure of the mesenteric defect is vital to avoid IH.
机器人辅助胰十二指肠切除术（RPD）被报道是安全且可行的。RPD 后发生内疝（IH）是一种严重但很少见的并发症。
我们回顾性分析了 2010 年 10 月至 2016 年 12 月期间接受 RPD 的 231 例患者的数据。研究了 IH 的发生率、症状、表现时间和结局。
5 例（2.6%）患者被诊断为 IH。证实 IH 与横结肠系膜缺损之间存在显著相关性（P<0.001）。在未闭合缺损的患者中，IH 的发生率为 62.5%，而接受缺损闭合的患者则未发生 IH。IH 发生的中位时间为初次手术后 76 天。主要症状为腹痛、恶心和呕吐。所有患者均接受了腹部计算机断层扫描（CT）检查，根据影像学和症状怀疑存在 IH。所有患者均接受了再次手术（2 例腹腔镜手术，3 例开腹手术）。中位住院时间为 13 天。治疗后无患者复发。
腹痛、恶心和呕吐是我们研究中接受 RPD 治疗的患者的常见症状。如果 CT 检查有阳性发现，应怀疑 IH。因为 IH 可能导致肠缺血，所以需要及时进行再次手术。仔细闭合肠系膜缺损对于避免 IH 至关重要。
