切换至 "中华医学电子期刊资源库"

中华肥胖与代谢病电子杂志 ›› 2022, Vol. 08 ›› Issue (02) : 73 -78. doi: 10.3877/cma.j.issn.2095-9605.2022.02.001

专家论坛

腹腔镜Roux-en-Y胃旁路术术后出血的预防及处理
赵稳1, 高文星1, 李丁昌1, 金露佳1, 陈鹏1, 武现生1, 董光龙1,()   
  1. 1. 100853 北京,解放军总医院第一医学中心普通外科医学部
  • 收稿日期:2022-03-26 出版日期:2022-05-30
  • 通信作者: 董光龙

Prevention and management of postoperative hemorrhage after laparoscopic Roux-en-Y gastric bypass

Wen Zhao1, Wenxing Gao1, Dingchang Li1, Lujia Jin1, Peng Chen1, Xiansheng Wu1, Guanglong Dong1,()   

  1. 1. Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2022-03-26 Published:2022-05-30
  • Corresponding author: Guanglong Dong
引用本文:

赵稳, 高文星, 李丁昌, 金露佳, 陈鹏, 武现生, 董光龙. 腹腔镜Roux-en-Y胃旁路术术后出血的预防及处理[J/OL]. 中华肥胖与代谢病电子杂志, 2022, 08(02): 73-78.

Wen Zhao, Wenxing Gao, Dingchang Li, Lujia Jin, Peng Chen, Xiansheng Wu, Guanglong Dong. Prevention and management of postoperative hemorrhage after laparoscopic Roux-en-Y gastric bypass[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(02): 73-78.

近年来,随着减重代谢手术的发展,腹腔镜Roux-en-Y胃旁路术(LRYGB)术后并发症的报道并不少见,其中出血是LRYGB术后最严重的并发症之一,有增加围术期再手术、患者死亡等严重不良事件发生风险。因此,预防和及早识别术后出血,并积极采取有效的治疗措施,是缩短治疗周期,避免不良事件发生的关键。本文将着重论述LRYGB术后出血并发症的危险因素、发病原因、预防以及诊治过程,总结出血防治经验。

In recent years, bariatric surgery has developed rapidly, and its surgical procedures are constantly being innovated. But the postoperative complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) are not rare, among which hemorrhage is one of the most serious complications after LRYGB, with an increased risk of serious adverse events such as perioperative reoperation and death.Therefore, identifying postoperative hemorrhage timely and taking effective measures promptly according to the clinical context are the keys to reducing the treatment cycle, and avoiding adverse events. This review article aims to conclude risks factors, causes, preventive measures and means of treatment for postoperative hemorrhage after LRYGB.

图1 LRYGB术后早期出血的处理流程图
[1]
Acquafresca PA, Palermo M, Rogula T, et al. Early surgical complications after gastric by-pass: a literature review [J]. Arq Bras Cir Dig, 2015, 28(1): 74-80.
[2]
Simillis C, Fachiri M, Bonanomi G. A challenging gastrointestinal hemorrhage after gastric bypass treated with interventional radiology [J]. Surg Obes Relat Dis, 2016, 12(7): e59-e62.
[3]
Bakhos C, Alkhoury F, Kyriakides T, et al. Early postoperative hemorrhage after open and laparoscopic roux-en-y gastric bypass [J]. Obes Surg, 2009, 19(2): 153-157.
[4]
Fecso AB, Samuel T, Elnahas A, et al. Clinical Indicators of Postoperative Bleeding in Bariatric Surgery[J]. Surg Laparosc Endosc Percutan Tech, 2018, 28(1): 52-55.
[5]
Susmallian S, Danoch R, Raskin B, et al. Assessing Bleeding Risk in Bariatric Surgeries: A Retrospective Analysis Study [J]. Dig Dis, 2020, 38(6): 449-457.
[6]
Finks JF, Kole KL, Yenumula PR, et al. Predicting risk for serious complications with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative [J]. Ann Surg, 2011, 254(4): 633-640.
[7]
Pereira A, Santos RF, Costa-Pinho A, et al. Early Postoperative Bleeding After Laparoscopic Roux-En-Y Gastric Bypass: a Single Center Analysis [J]. Obes Surg, 2022, 32(6): 1902-1908.
[8]
Janik MR, Aryaie AH. The effect of smoking on bariatric surgical 30-day outcomes: propensity-score-matched analysis of the MBSAQIP [J]. Surg Endosc, 2021, 35(7): 3905-3914.
[9]
Zafar SN, Miller K, Felton J, et al. Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences [J]. Surg Endosc, 2019, 33(1): 272-280.
[10]
Sharma G, Hanipah ZN, Aminian A, et al. Bariatric Surgery in Patients on Chronic Anticoagulation Therapy [J]. Obes Surg, 2018, 28(8): 2225-2232.
[11]
Nguyen NT, Wolfe BM. The physiologic effects of pneumoperitoneum in the morbidly obese [J]. Ann Surg, 2005, 241(2): 219-226.
[12]
Umar A, Mehta KS, Mehta N. Evaluation of hemodynamic changes using different intra-abdominal pressures for laparoscopic cholecystectomy [J]. Indian J Surg, 2013, 75(4): 284-289.
[13]
Pyke O, Yang J, Cohn T, et al. Marginal ulcer continues to be a major source of morbidity over time following gastric bypass [J]. Surg Endosc, 2019, 33(10): 3451-3456.
[14]
Süsstrunk J, Wartmann L, Mattiello D, et al. Incidence and Prognostic Factors for the Development of Symptomatic and Asymptomatic Marginal Ulcers After Roux-en-Y Gastric Bypass Procedures [J]. Obes Surg, 2021, 31(7): 3005-3014.
[15]
Rodrigo DC, Jill S, Daniel M, et al. Which Factors Correlate with Marginal Ulcer After Surgery for Obesity? [J]. Obes Surg, 2020, 30(12): 4821-4827.
[16]
Mocanu V, Dang JT, Switzer N, et al. The Effect of Helicobacter pylori on Postoperative Outcomes in Patients Undergoing Bariatric Surgery: a Systematic Review and Meta-analysis [J]. Obes Surg, 2018, 28(2): 567-573.
[17]
Heneghan HM, Meron-Eldar S, Yenumula P, et al. Incidence and management of bleeding complications after gastric bypass surgery in the morbidly obese [J]. Surg Obes Relat Dis, 2012, 8(6): 729-735.
[18]
Rabl C, Peeva S, Prado K, et al. Early and late abdominal bleeding after Roux-en-Y gastric bypass: sources and tailored therapeutic strategies [J]. Obes Surg, 2011, 21(4): 413-420.
[19]
Shikora SA, Mahoney CB. Clinical Benefit of Gastric Staple Line Reinforcement (SLR) in Gastrointestinal Surgery: a Meta-analysis [J]. Obes Surg, 2015, 25(7): 1133-1141.
[20]
Borjas G, Gonzalez M, Maldonado A, et al. Oversewing staple line of the gastric remnant in gastric bypass reduces postoperative bleeding [J]. Ann Med Surg (Lond), 2021, 67: 102534.
[21]
Alasfar F, Chand B. Intraoperative endoscopy for laparoscopic Roux-en-Y gastric bypass: leak test and beyond [J]. Surg Laparosc Endosc Percutan Tech, 2010, 20(6): 424-427
[22]
中国研究型医院学会糖尿病与肥胖外科专业委员会. 减重与代谢外科加速康复外科原则中国专家共识(2021版) [J/CD]. 中华肥胖与代谢病电子杂志, 2021, 7(03): 141-145.
[23]
胡瑞翔,杨景哥,杨华, 等. 450例腹腔镜Roux-en-Y胃旁路术后并发症的分析及处理 [J]. 中华消化外科杂志, 2017, 16(06): 582-586.
[24]
王勇,张旭. 减重及代谢疾病病人围手术期静脉血栓栓塞症预防[J]. 中国实用外科杂志, 2017, 37(02): 129-132.
[25]
Odutayo A, Desborough MJ, Trivella M, et al. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials [J]. Lancet Gastroenterol Hepatol, 2017, 2(5): 354-360.
[26]
Marmo R, Rotondano G, Piscopo R, et al. Dual therapy versus monotherapy in the endoscopic treatment of high-risk bleeding ulcers: a meta-analysis of controlled trials [J]. Am J Gastroenterol, 2007, 102(2): 279-289.
[27]
Chahal D, Sidhu H, Zhao B, et al. Efficacy of Hemospray (TC-325) in the Treatment of Gastrointestinal Bleeding: An Updated Systematic Review and Meta-analysis [J]. J Clin Gastroenterol, 2021, 55(6): 492-498.
[1] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[2] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[3] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[4] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[5] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[6] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[7] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[8] 刘柏隆, 周祥福. 女性尿失禁吊带手术并发症处理的经验分享[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 127-127.
[9] 嵇振岭, 陈杰, 唐健雄. 重视复杂腹壁疝手术并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 601-606.
[10] 江志鹏, 钟克力, 陈双. 复杂腹壁疝手术后腹腔高压与腹腔间室综合征的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 612-615.
[11] 王学虎, 赵渝. 复杂腹壁疝手术中血管损伤并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 616-619.
[12] 杭轶, 杨小勇, 李文美, 薛磊. 可控性低中心静脉压技术在肝切除术中应用的最适中心静脉压[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 813-817.
[13] 石阳, 于剑锋, 曹可, 翟志伟, 叶春祥, 王振军, 韩加刚. 可扩张金属支架置入联合新辅助化疗治疗完全梗阻性左半结肠癌围手术期并发症分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 464-471.
[14] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[15] 董晟, 郎胜坤, 葛新, 孙少君, 薛明宇. 反向休克指数乘以格拉斯哥昏迷评分对老年严重创伤患者发生急性创伤性凝血功能障碍的预测价值[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 541-547.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?