腹腔镜袖状胃切除术后胃漏2例诊疗体会  

The experience of diagnosis and treatment of gastric leakage after laparoscopic sleeve gastrectomy in 2 cases

作　　者：田峰 杨晓平 吴建林[1] 谭延禄 雷森 刘志民[1] TIAN Feng;YANG Xiao-ping;WU Jian-lin(Department of Laparoscopic General Surgery,Zibo Central Hospital,Zibo 255036,China)

机构地区：[1]淄博市中心医院

出　　处：《腹腔镜外科杂志》2019年第6期405-409,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜袖状胃切除术后胃漏的发生原因及治疗方法。方法:回顾分析2015年5月至2018年12月接受LSG术后发生胃漏的2例患者的临床资料。结果:病例1男性,33岁,BMI34.68kg/m^2,术前诊断为原发性肥胖症及胃间质瘤,行腹腔镜袖状胃切除术+腹腔镜胃间质瘤切除术,为第15例LSG患者,术后第7天发生胃漏;病例2为女性,28岁,BMI53.65kg/m^2,术前诊断为代谢综合征及食管裂孔疝,行腹腔镜袖状胃切除术+食管裂孔疝修补术,为第30例LSG患者,术后第8天患者出院,第22天发生胃漏。采用三腔喂养管,同时行胃肠减压、胃瘘口冲洗及肠内营养,并予以黎氏管腹腔冲洗引流,2例胃漏患者分别于治疗后63d及17d复查上消化道造影,提示治愈。结论:应用三腔喂养管行胃瘘口冲洗及肠内营养、黎氏管腹腔持续冲洗引流,可有效控制腹腔感染,提高胃漏治愈率,操作简单、易行,效果确切、安全,值得临床推广。Objective:To investigate the causes and treatment of gastric leakage after laparoscopic sleeve gastrectomy ( LSG). Methods:The clinical data of 2 patients of gastric leakage after LSG who had undergone LSG between May 2015 and Dec.2018 were retrospectively analyzed.Results:Patient one was male and 33 years old,his BMI was 34.68 kg /m^2,the preoperative diagnoses were primary obesity and gastric stromal tumor,he underwent LSG and laparoscopic resection of gastric stromal tumor,and was the 15th patient who was enrolled to undergo LSG in Zibo central hospital,the gastric leakage was confirmed on the 7th postoperative day.Patient two was female and 28 years old,her BMI was 53.65 kg /m^2,the preoperative diagnoses were metabolic syndrome and esophageal hiatal hernia, she underwent LSG and laparoscopic esophageal hiatal hernia repair,and was the 30th patient who was enrolled to undergo LSG in Zibo central hospital,she was discharged on the 8th postoperative day and gastric leakage was confirmed on the 22nd postoperative day. The two patients of gastric leakage were all given gastrointestinal decompression,lavage for gastric fistula and enteral nutrition by Freka Trelumina,and persistent peritoneal lavage and drainage by Li's drainage tube.Reexamination of upper gastrointestinal radiography showed they were respectively cured after 63 d and 17 d.Conclusions:Lavage for gastric fistula and enteral nutrition by Freka Trelumina and persistent peritoneal lavage and drainage by Li's drainage tube could effectively control abdominal infection and increase the cure rate of gastric leakage,the approach has the advantage of easy operation,feasibility,safety and generalized value.

关 键 词：袖状胃切除术 腹腔镜检查 胃漏 

分 类 号：R656.61[医药卫生—外科学]