关键词: 胃肿瘤, 胃切除术, 内疝, Petersen疝, 小肠系膜裂孔疝

Abstract: Clinical characteristics and management of internal hernia after gastrectomy in patients with gastric cancer               ZHANG Qi*，YU Wen-hao，ZHOU Jia-jie，et al. *Department of General Surgery，Northern Jiangsu People's Hospital，Clinical Medical College，Yangzhou University and Medical School of Nanjing University；General Surgery Institute of Yangzhou，Yangzhou University，Yangzhou 225000，China
Corresponding author：WANG Dao-rong，E-mail：wdaorong666@sina.com
ZHANG Qi, YU Wen-hao and ZHOU Jia-jie are the first authors who contributed equally to the article
Abstract    Objective    To analyze the clinical characteristics of internal hernia after radical resection of gastric cancer and summarize the experience of diagnosis and treatment. Methods    The clinical data of 15 patients with intestinal obstruction due to internal hernia confirmed during operation and who had undergone gastrectomy in the past admitted by Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University from May 2014 to April 2022 were analyzed retrospectively, all of whom underwent surgical treatment and the clinical effect was observed and followed up. Results    There were 15 patients in the whole group, including 9 Petersen hernias and 6 jejunojejunostomy mesenteric hernias; The symptoms were 10（1~63） months after gastrectomy. 12 patients underwent emergency laparotomy, and 3 patients received laparotomy after ineffective conservative treatment. In 7 patients with Petersen’s hernia, the blood supply was restored after intestinal reduction, and the Petersen space was closed. In 2 patients, intestinal necrosis was confirmed during the operation, and necrotic small bowel resection and closure of Petersen’s space were performed. 6 cases of jejunojejunostomy mesenteric hernias：5 cases of internal hernia were recovered and intermittently sutured jejunojejunostomy mesenteric defect. One patient was confirmed to have terminal ileal strangulation and necrosis during operation and underwent partial small bowel resection to close the jejunojejunostomy mesenteric defect. All patients did not have complications of Clavien-Dindo grade Ⅲ or above after operation. The overall postoperative hospitalization（8.8±1.6）days. After operation，2 patients with intermittent suture of mesenteric space developed jejunojejunostomy mesenteric hernias again. Conclusion    Once an internal hernia is suspected, an abdominal CT examination should be promptly completed, and surgical treatment should be initiated. In order to reduce the occurrence of internal hernia，we recommend the routine use of non-absorbable sutures for continuous closure of the mesentery gap during radical gastrectomy.

Key words: gastric cancer, gastrectomy, internal hernia, Petersen’s hernia, jejunojejunostomy mesenteric hernia