减重代谢手术后消化道漏的发生机制与诊疗进展

Mechanisms and treatment advances of gastrointestinal leak after bariatric and metabolic surgery

减重代谢手术是治疗肥胖及代谢综合征的有效手段。近年来减重代谢外科发展迅速,手术指征及手术方式逐渐成熟,同时手术相关并发症也得到了广泛探讨,包括减重代谢手术特有的并发症以及胃肠道手术共有的风险,其中消化道漏是主要且严重的并发症之一,严重时可危及生命。本文基于减重代谢手术的两种主要术式造成的消化道漏,即腹腔镜胃袖状切除术后胃切缘漏和腹腔镜Roux-en-Y胃旁路术后胃空肠吻合口漏展开讨论,就减重代谢手术后消化道漏相关的发生机制、临床表现、诊断策略、预防以及治疗的进展进行综述。

Bariatric and metabolic surgery is an effective treatment for obesity and metabolic syndrome with definite results.In recent years,bariatric and metabolic surgery has developed rapidly,and the surgical indications and procedures have gradually matured.At the same time,the complications have also been widely discussed,including those specific to bariatric metabolic surgery and the risks common to gastrointestinal surgery,of which gastrointestinal leak is one of the most important and serious complications,which can be life-threatening in severe cases.This paper will review the mechanisms,clinical manifestations,diagnostic strategies,prevention,and treatment advances related to gastrointestinal leak after bariatric metabolic surgery based on the two major procedures that cause gastrointestinal leak,namely,staple line leak after laparoscopic sleeve gastrectomy and gastrojejunostomy leak after laparoscopic Roux-en-Y gastric bypass.