Roux-en-Y胃旁路术后空肠吻合口扭结的发生机制与临床处理

Mechanisms and clinical management of small bowel obstruction caused by kinking of the jejunojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass

当前,肥胖及其并发症已成为日益严重的健康问题,减重代谢手术是治疗肥胖及其相关代谢并发症的有效方法。Roux-en-Y胃旁路术(RYGB)被认为是减重代谢手术的"金标准"术式。小肠梗阻是RYGB术后可能发生的并发症,除了腹内疝形成之外,空肠吻合口扭结也是其重要原因。空肠吻合口扭结的早期临床症状往往并不明显,因此,对空肠吻合口扭结患者做到早诊断、早预防及有效治疗,是难点也是关键。空肠吻合口扭结的发生可能与手术技术和术者经验有关,使用抗梗阻缝合、肠系膜分割与空肠-空肠双向侧侧吻合等手段对预防空肠吻合口扭结可能有益。如果发生空肠吻合口扭结,应及时进行腹部CT扫描和消化内镜检查,及时给予胃肠减压并准备手术探查。

Currently,obesity and its complications have become increasingly serious health issues.Bariatric surgery is an effective method of treating obesity and related metabolic complications.Among them,Roux-en-Y gastric bypass(RYGB)is still considered the“gold standard”procedure for bariatric surgery.Small bowel obstruction is one of the possible complications after RYGB,and in addition to the formation of intra-abdominal hernias,kinking of the jejunojejunal anastomosis is an important cause of small bowel obstruction.The early clinical symptoms of kinking of the jejunojejunal anastomosis often lack clarity in the early stages.Therefore,early diagnosis,prevention,and effective treatment of kinking of the jejunojejunal anastomosis are challenging but crucial.The occurrence of kinking of the jejunojejunal anastomosis may be related to surgical techniques and the surgeon′s experience.The use of anti-obstruction stitch,mesenteric division,and bidirectional jejunojejunal anastomosis may be beneficial in preventing kinking of the jejunojejunal anastomosis.If kinking of the jejunojejunal anastomosis occurs,timely abdominal CT scans and endoscopic examinations should be performed.Gastric and intestinal decompression should be initiated immediately,and exploratory surgery should be prepared.