腹腔镜袖状胃切除术后胃漏的预防和治疗策略:3760例患者的回顾性分析

Prevention and treatment strategies for postoperative gastric leak after laparoscopic sleeve gastrectomy:A retrospective analysis of 3760 patients

目的总结腹腔镜袖状胃切除术(LSG)后胃漏的防治策略。方法回顾性分析2012年1月至2022年12月在暨南大学附属第一医院接受LSG手术以及外院转入行修正手术治疗的共3760名肥胖症患者的临床资料,包括年龄、性别、手术方式、胃漏诊断时间、糖尿病和高血压等合并症、术前BMI、术后胃漏的主要症状以及采取的治疗措施和愈合时间。结果在接受LSG的3760例患者中,有14例(0.37%)出现了胃漏。胃漏的诊断时间的中位数为4.50天,85.7%的胃漏发生在胃袖上方。上部和下部胃漏的愈合时间之间没有统计学上的显著差异(P>0.05)。在术后出现胃漏的患者中,1例(7.1%)接受了保守+手术(CS)治疗,10例(71.4%)接受了内镜+手术(ES)治疗,3例(21.4%)接受了保守+内镜+手术(CES)治疗。胃漏的中位愈合时间为29.5天。57.1%的患者在初始治疗失败后需要进行第二次治疗甚至多次治疗。结论根据LSG术后胃漏的临床特点进行分类有助于选择最佳的治疗方案。预防是管理LSG术后胃漏的关键,Roux-en-Y胃旁路术(RYGB)是用于治疗严重肥胖症的首选手术方式。

Objective Summarizing the prevention and treatment strategies for gastric leak after laparoscopic sleeve gastrectomy(LSG).Methods A retrospective analysis of 3760 patients with obesity who underwent LSG in the First Hospital of Jinan University or transferred from other hospital for revision surgery from January 2012 to December 2022.We conducted a retrospective analysis of the clinical data of these patients,including age,gender,surgical approach,time of gastric leak diagnosis,comorbidities such as diabetes and hypertension,preoperative BMI,main symptoms of postoperative gastric leak,treatment measures taken,and healing time.Results In the 3760 patients who underwent LSG,14 cases(0.37%)experienced gastric leak.The median time to diagnose gastric leak was 4.50 days,with 85.7%of leaks occurring above the gastric sleeve.There was no statistically significant difference in healing time between upper and lower gastric leaks(P>0.05).Among the patients who experienced postoperative gastric leak,1 case(7.1%)underwent conservative+surgical(CS)treatment,10 cases(71.4%)received endoscopy+surgical(ES)treatment,and 3 cases(21.4%)underwent conservative+endoscopy+surgical(CES)treatment.The median healing time for gastric leaks was 29.5 days.57.1%of patients required a second or even multiple treatments after initial treatment failure.Conclusions Classifying gastric leaks after LSG based on their clinical characteristics can help select the optimal treatment approach.Prevention is key in managing gastric leaks after LSG,and Roux-en-Y gastric bypass surgery(RYGB)is a preferred surgical option for treating severe obesity.