University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil.
JSLS. 2020 Oct-Dec;24(4). doi: 10.4293/JSLS.2020.00061.
Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial.
Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital.
Thirty patients (34 surgical procedures - 4 re-operations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 ± 32.65 and the mean body mass index was 27.11 ± 3.5 kg/m. The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 ± 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 ± 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 ± 32.6 months.
Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.
胃扭转是一种罕见的疾病，其特征为胃异常旋转，导致梗阻并伴有缺血、坏死和穿孔的风险。它与高发病率和死亡率相关，由于它危及生命，因此早期诊断和治疗至关重要。
对 2000 年 1 月至 2018 年 12 月期间在一所大学医院接受视频腹腔镜治疗的胸腔内胃扭转患者的病历进行回顾性研究。
30 例患者（34 例手术——4 例再次手术），9 例（30%）为男性，21 例（70%）为女性。平均年龄为 57.65 ± 32.65 岁，平均体重指数为 27.11 ± 3.5 kg/m。最常见的症状是上腹痛和吞咽困难。在 41.17%的病例中，对比 X 射线证实了诊断。所有 34 例均为胸腔内扭转，其中 24 例为器官轴性（70.58%）。使用的手术技术为胃底折叠术，无网片（25 例；73.52%）和带加固网片（9 例；26.47%），大多与尼森胃底折叠术相关（52.94%）。平均手术时间为 215.7 ± 62.9 分钟，5 例（15.62%）转为开腹。无手术死亡记录，100%的患者症状改善。患者的平均随访时间为 41.8 ± 32.6 个月。
手术治疗应作为降低发病率和死亡率的手段，并改善症状和患者预后。胸腔内胃扭转的腹腔镜手术被证明是安全有效的，应成为治疗这种疾病的首选方法。
