Roux-en-Y胃旁路术后边缘溃疡1例并文献复习  

Marginal ulcer after Roux-en-Y gastric bypass:one case report with a literature review

作　　者：曹耀权 王文博 朱晒红[1] 朱利勇[1] Cao Yaoquan;Wang Wenbo;Zhu Shaihong;Zhu Liyong(Department of Bariatric&Metabolic Surgery,Third Xiangya Hospital,Central South University,Hunan Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院减重代谢外科,湖南长沙410013

出　　处：《腹部外科》2024年第5期356-360,377,共6页Journal of Abdominal Surgery

基　　金：国家自然科学基金面上项目(82370676);湖南省重点研发项目(2022SK2001)。

摘　　要：边缘溃疡是胃旁路术后典型的并发症,处理不当将导致穿孔、出血或狭窄等严重后果。中南大学湘雅三医院收治1例Roux-en-Y胃旁路术后并发吻合口边缘溃疡病人,该例病人因代谢综合征于2011年4月行腹腔镜下Roux-en-Y胃旁路术。2017年9月起反复出现腹痛、伴有大便性状改变。完善检查后诊断为边缘溃疡,考虑为胃囊扩大所致,遂于2019年10月行腹腔镜下扩张胃囊减容术+部分小肠切除术。术后病人规律行抑酸护胃治疗,但仍反复出现腹痛,伴有恶心呕吐,行胃镜提示吻合口边缘溃疡仍未愈合。遂于2022年6月完善术前准备后行腹腔镜下胃部分-胃肠吻合口-营养支空肠切除术+胃旁路修正手术。术后病人症状明显改善,8个月后随访胃镜下未见明显溃疡征象。此例病人历经2次修正手术,前后历时近5年,方得以治愈,显示此并发症处理难度大,过程繁琐。作者对胃旁路术后边缘溃疡这一并发症进行了相关文献复习,对此类并发症的危险因素、治疗及预防策略进行了总结,以期为减重代谢外科临床医师提供参考。Marginal ulcer is a common complication after Roux-en-Y gastric bypass and its improper management may cause serious consequences,including perforation,hemorrhage and stenosis.This report described one female case of anastomotic marginal ulcer after Roux-en-Y gastric bypass.She initially underwent laparoscopic Roux-en-Y gastric bypass in April 2011 for metabolic syndrome.In September 2017,there was an onset of recurrent abdominal pain with altered stool consistency.After thorough examinations,marginal ulcer was diagnosed due probably to an enlargement of gastric pouch.Consequently,in October 2019,laparoscopic sleeve gastrectomy was performed along with partial small bowel resection.Despite regular postoperative dosing of antacids,recurrent abdominal pain,nausea and vomiting persisted.Follow-up gastroscopy revealed non-healing of anastomotic marginal ulcer.In June 2022,after completing thorough preoperative preparation,laparoscopic partial gastric-gastrointestinal anastomosis,nutritional branch jejunostomy and gastric bypass revision were performed.Postoperative symptoms improved markedly.Follow-up gastroscopy at Month 8 showed no sign of ulceration.This case illustrated the challenge of managing marginal ulcers since two revision operations over nearly 5 years were required for curing.Focusing upon the relevant literature on marginal ulcers after Roux-en-Y gastric bypass,this review summarized risk factors,treatments and prevention strategies to provide references for bariatric and metabolic surgeons.

关 键 词：ROUX-EN-Y胃旁路术 减重代谢手术 并发症 边缘溃疡 修正手术 

分 类 号：R656[医药卫生—外科学]