CAJ | 학술논문

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.
목적 탐토복강경하위방로수술병발증적처리급예방.방법 회고성분석2010년5월지2013년5월간재소주대학부속제일의원복강경외과접수복강경하위방로수술적82례환자(단순성비반9례、비반합병2형당뇨병55례,비비반단순2형당뇨병18례)림상자료,탐토해술식병발증발생적원인,총결경험급교훈.결과 전조무술후사망환자,기중9례(11.0％)환자유병발증발생,기중천자손상1례(1.2％)중전개복행봉찰지혈;문합구출혈4례(4.9％,1례합병문합구궤양),경거갑신상선소생리염수세위혹내경하전작지혈후치유;문합구루1례(1.2％),방치비-공장영양관、여전장내영양1개월후루구유합;문합구협착1례(1.2％),행구낭확장후출현미만성복막염,수행복강경하수보술;위탄2례(2.4％),경금식、위장감압、위장동력약물급장내영양등보수치료호전.소유병발증균치유.수방19.0～35.0(29.1±5.4)월,전조환자체질량지수교술전균유불동정도적하강.결론 위방로수술수연유일정적풍험,단가통과적겁적술전준비、제고수술정세정도급세치적술후호리급관찰래예방병발증적발생,이즉편발생료병발증,야유치료조시가순.
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 nose-gastro 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.