腹腔镜可调节胃束带术后并发症及治疗

Management of complications after laparoscopic adjustable gastric banding

目的探讨腹腔镜可调节胃束带术（LAGB）后并发症及治疗方法。方法回顾性分析2005年9月至2011年6月天津市南开医院行LAGB随访2年以上的83例肥胖症患者的临床资料。腹腔镜下放置胃束带，使束带上方形成1个容量约20～30ml胃小囊，将注水泵埋于剑突下腹直肌前鞘浅面。在术后4周根据患者体质量变化、餐后症状及上消化道造影情况，对胃束带进行注水调节。采用门诊和电话方式进行随访，随访时间截至2013年7月。结果83例患者并发症发生率为44．6％（37／83），其中早期并发症（1个月内）6例、远期并发症31例。早期并发症主要表现为进食后呕吐，5例患者通过减慢进食速度、减少进食量后缓解；1例患者症状严重，予禁食水并营养支持，5d后症状缓解。远期并发症中，25例患者发生束带腐蚀胃壁并向胃腔内移位（其中6例合并注水泵处感染），通过腹腔镜手术（早期1例行开腹手术）将胃束带取出，并缝合胃壁穿孔处获得治愈；10例患者发生注水泵相关并发症（6例为上述注水泵感染者，4例为注水泵移位），通过手术将注水泵取出；2例发生束带滑动移位，通过抽净注水泵内生理盐水，改为流质饮食，减少进食量后，1例患者束带位置恢复正常，另1例患者无变化，行腹腔镜手术取出胃束带。结论LAGB术后并发症发生率较高，并随着术后时间的延长而增高，远期并发症多数需要再次手术治疗。

Objective To investigate the management of complications after laparoscopic adjustable gastric banding （ LAGB ）. Methods The clinical data of 83 obese patients who were treated by LACB at the Nankai Hospital from September 2005 to June 2011 were retrospectively analyzed. The complications after LAGB were analyzed. The adjustable gastric band was installed under laparoscope so as to form a small gastric pouch with a volume ranged between 20-30 ml. The water pump was fixed in the rectus abdominis anterior sheath under the appendix ensiformis. The gastric band was adjusted according to the changes of the body weight, symptoms after diet and results of imaging examination of upper gastrointestinal tract. Patients were followed up via out-patient examination and phone call till July 2013. Results The incidence of complications of the 83 patients was 44.6% （37/83）. Six patients had short-term complications and 31 patients had long-term complications. The short-term complication mainly presented as post-prandial vomiting. The symptoms of 5 patients were relieved by changing of eating habit. The condition of 1 patient was severe, and the symptom was relieved 5 days later after fasting and nutritional support. For the 31 patients with long-term complications, 25 were complicated with band erosion into gastric lumen via gastric wall （6 patients were complicated with infection of the water pump site）, and they were cured by removal of band laparoscopiely. Ten patients were complicated with water pump-related complications, including 6 with infection of the water pump site and 4 with pump migration. The water pumps of the 4 patients with pump migration were surgically removed. Two patients had band slipping to the stomach. The band was restored to the original place after removing the liquid from the band and reducing the food intake, and then the position of the band in 1 patient was restored to normal, and no change was observed in another patient, and the band was removed laparoscopicly. Conclusions The incidence of complications after LAGB is high, and it increases as the time passes by. Most of the long-term complications after LAGB need to be treated by reoperation.