Diagnosis and Treatment of Afferent Loop Obstruction after Billroth-ⅡSubtotal Gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 郑建伟 ,  蔡淑艳

首都医科大学附属北京朝阳医院京西院区普外科（北京 100043）;

Corresponding author：

蔡淑艳, Email: catcaisy@yeah.Net

Keywords：

胃大部切除术; 输入袢梗阻; 手术治疗

DOI：

10.7507/1007-9424.20140210

Video：

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目的探讨Billroth-Ⅱ胃大部切除术后输入袢梗阻的诊断和手术方式。方法本组共17例输入袢梗阻患者，对17例患者的手术史、临床表现及影像学资料进行总结分析。结果典型的输入袢梗阻表现为上腹胀痛、上腹部触及张力较高且有压痛的囊性包块，腹部CT检查见腹主动脉与肠系膜上动脉之间横向走行的扩张肠管。17例患者均再次行剖腹探查术，术中见输入袢扩张，5例行Braun吻合术，12例行Roux-en-Y吻合术。术后无严重合并症，无围手术期死亡，患者均恢复顺利，梗阻症状消失。术后随访1～4年（平均2.5年），经X线胃肠钡餐检查见吻合口钡剂通过顺利，无狭窄；胃镜检查未见胆汁反流。结论严格遵守正确的手术操作常规是预防输入袢梗阻的关键；经腹部CT诊断明确后，应尽早再手术；Braun吻合术及Roux-en-Y吻合术为胃大部切除术后输入袢梗阻较理想的术式。

Citation： 郑建伟, 蔡淑艳. Diagnosis and Treatment of Afferent Loop Obstruction after Billroth-ⅡSubtotal Gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(7): 883-885. doi: 10.7507/1007-9424.20140210 Copy

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14.	刘士洪.急性输入袢梗阻7例报告[J].南京医科大学学报, 1997, 17(3):295.
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1. 万进.关于胃大部切除术后输入袢综合症问题[J].临床外科杂志, 2001, 9(6):349-350.
2. 毕建威.胃手术后梗阻并发症及处理[J].中国实用外科杂志, 2013, 33(4):309-312.
3. Whitaker WG Jr, Rome JS. Chronic afferent loop obstruction[J]. Am Surg, 1971, 37(12):753-755.
4. Chevallier P, Gueyffier C, Souci J, et al. MRI of an afferent loop syndrome presenting as obstructive icterus[J]. J Radiol, 2001, 82(2):177-179.
5. Carbognin G, Biasiutti C, EI-Khaldi M, et al. Afferent loopsyndrome presenting as enterolith after Billroth-Ⅱsubtotal gastrectomy; a case report[J]. Abdom Imaging, 2000, 25(2):129-131.
6. 鉴敬仁.胃部分切除后输入襻梗阻十二指肠部分坏死3例报告[J].中国实用外科杂志, 2003, 23(7):445-446.
7. 何博华. Billroth-Ⅱ术后输入襻梗阻的临床分析[J].中华普通外科杂志, 2006, 21(6):443-445.
8. Gayer G, Barsuk D, Hertz M, et al. CT diagnosis of afferent loop obstruction[J]. Clinical Radiology, 2002, 57(9):835-839.
9. Kim HC, Han JK, Kim KW, et al. Afferent loop obstruction after gastric cancer surgery:helical CT findings[J]. Abdom Imaging, 2003, 28(5):624-630.
10. 文洪明.布朗氏吻合对胃大部分切除术后并发症的预防作用[J].华南大学学报:医学版, 2001, 29(1):85-86.
11. Kim YH, Han JK, Lee KH, et al. Paliative percutaneous tube entorostomy in afferent-loop syndrome presenting as jaundice: clinical effectimeness[J]. J Vasc Interv Radiol, 2002, 13(8): 845-849.
12. 武正炎.普通外科手术并发症预防与处理[M].北京:人民军医出版社, 2002:173-175.
13. Morii Y, Arita T, Shimoda K, et al. Jejunal interposition to prevent postgastrectomy syndromes[J]. Br J Surg, 2000, 87(11):1576-1579.
14. 刘士洪.急性输入袢梗阻7例报告[J].南京医科大学学报, 1997, 17(3):295.
15. 孙衍庆.现代外科手术并发症学[M].北京:世界图书出版公司, 2003:673-674.
16. 管小青.胃大部切除术后输入袢急性梗阻诊治体会(附5例报告)[J].临床急诊杂志, 2007, 8(1):37-39.

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Diagnosis and Treatment of Afferent Loop Obstruction after Billroth-ⅡSubtotal Gastrectomy

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