胃切除術後Petersen's defectへ内ヘルニアを発症した11例の検討

Review of 11 patients with Petersen's hernia after gastrectomy for gastric cancer

◆要旨：胃癌に対する胃切除術後Petersen'sヘルニアを発症した11例を検討した．初回術式は開腹幽門側胃切除術4例，腹腔鏡下幽門側胃切除術5例，腹腔鏡下胃全摘術2例であった．発症時の年齢中央値は64歳で，男性9例，女性2例であった．主訴は全例腹痛であった．胃切除後の体重減少率は平均13.0％であった．全症例でPetersen's defectは閉鎖されていなかった．腹部単純X線検査で異常を指摘しえたのは5例（45.5％）のみで，CT検査ではwhirl signを全例に指摘しえた．小腸壊死に陥った症例はなく，全例にヘルニア解除術とPetersen's defectの閉鎖術が行われた．Roux-en-Y再建後の患者が腹痛を訴えた場合には，内ヘルニアを疑いCT検査を行うことで早期診断できると考えられた．

Clinical information was collected from medical records for 11 patients who had symptom of Petersen's hernia after gastrectomy for gastric cancer from December 2004 to March 2011. Petersen's hernia occurred in 4 patients with open distal gastrectomy（ODG）, 5 patients with laparoscopic distal gastrectomy（LDG） and 2 patients with laparoscopic total gastrectomy（LTG）. The patients included 2 women and 9 men, and the median age was 64 years. The chief complaint was abdominal pain in all patients. The mean body weight reduction after gastrectomy was 13.0％. In no patients, closing of Petersen's defect was undergone at gastrectomy. Abdominal radiograph was conducted in all cases, and abnormalities were identified in only five patients（45.5％）. By CT scan, whirl sign was identified in all patients. The hernia reduction and the closing of Petersen's defect were performed to all the patients. If a patient with a history of Roux-en-Y reconstruction complains of abdominal pain, an early diagnosis may be possible by suspecting internal hernia and conducting CT scan.