摘要
目的 探讨腹腔镜下胃旁路手术并发症的处理及预防.方法 回顾性分析2010年5月至2013年5月间在苏州大学附属第一医院腹腔镜外科接受腹腔镜下胃旁路手术的82例患者（单纯性肥胖9例、肥胖合并2型糖尿病55例,非肥胖单纯2型糖尿病18例）临床资料,探讨该术式并发症发生的原因,总结经验及教训.结果 全组无术后死亡患者,其中9例（11.0％）患者有并发症发生,其中穿刺损伤1例（1.2％）中转开腹行缝扎止血;吻合口出血4例（4.9％,1例合并吻合口溃疡）,经去甲肾上腺素生理盐水洗胃或内镜下电灼止血后治愈;吻合口瘘1例（1.2％）,放置鼻-空肠营养管、予全肠内营养1个月后瘘口愈合;吻合口狭窄1例（1.2％）,行球囊扩张后出现弥漫性腹膜炎,遂行腹腔镜下修补术;胃瘫2例（2.4％）,经禁食、胃肠减压、胃肠动力药物及肠内营养等保守治疗好转.所有并发症均治愈.随访19.0～35.0（29.1±5.4）月,全组患者体质量指数较术前均有不同程度的下降.结论 胃旁路手术虽然有一定的风险,但可通过积极的术前准备、提高手术精细程度及细致的术后护理及观察来预防并发症的发生,而即便发生了并发症,也有治疗措施可循.
Objective To investigate the prevention and management of complications after laparoscopic gastric bypass （LRYGB） operation.Methods Clinical data of 82 cases （9 cases of simple obesity,55 of obesity complicated with type 2 diabetes,18 of non-obesity simple type 2 diabetes） undergoing LRYGB in our hospital between May 2010 to May 2013 were retrospectively analyzed.Cause of complication was explored and experience was summarized in order to provide reference to clinical practice.Results Results There was no mortality and re-admission within 30 days after procedures.Nine patients developed complications.Punctural injury occurred in 1 patient （1.2%） and laparotomy surgery was performed to stop bleedind.Hemorrhage was observed in 4 patients（4.9%,one patients had concurrent anastomotic ulcer） and was cured by either gastrolavage with solution of epinephrine and normal saline or cautery under gastroscope.Anastomotic leakage occurred in one patient （1.2%） which was cured by placing nosegastro tube immediately after diagnosis of leakage and total enteral nutrition for one month.Anastomotic stricture occurred in 1 patient （1.2%）,general peritonitis occurred after balloon dilation and laparoscopic repair was performed to repair the peroration due to dilation.Gastroplegia occurred in two patients （2.4%） and was cured after fasting,gastrointestinal decompression,usage of gastrointestinal prokinetic medications and enteral nutrition.All complications were cured at last.BMI of all patients dropped in vary extent after a follow up of 19.0-35.0 （29.1 ±5.4） months.Conclusions Complication after LRYGB operation may be prevented by active preoperative preparation,surgical precision,and intensive postoperative care.Even complications occur,the corresponding treatments are effective.
出处
《中华胃肠外科杂志》
CAS
CSCD
2014年第7期663-666,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
胃旁路术
腹腔镜
并发症
预防
Gastric bypass
Laparoscopic
Complications
Preventions
