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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2023, Vol. 09 ›› Issue (01) : 55 -61. doi: 10.3877/cma.j.issn.2095-9605.2023.01.011

综述

腹腔镜袖状胃切除术后胃漏的研究进展及诊治体会
毛尔东, 杨金伟, 吴边, 尚云†()   
  1. 650032　昆明，昆明理工大学附属医院普外二科；650032　昆明，云南省第一人民医院普外二科
    650032　昆明，云南省第一人民医院普外二科；650500　昆明，昆明医科大学神经科学研究所
    650032　昆明，云南省第一人民医院普外二科
  • 收稿日期:2022-10-03 出版日期:2023-02-28
  • 通信作者: 尚云
  • 基金资助:
    云南省"万人计划"名医项目(YNWR-MY-2018-015); 云南省教育厅科学研究基金项目(2023Y0603); 云南省基础研究计划项目(202301AT070271); 云南省科技厅科技计划项目昆医联合专项(202101AY070001-253); 云南省高层次卫生计生技术人才培养经费资助(H-2019036)

Research progress and experience of diagnosis and treatment of gastric leakage after laparoscopic sleeve gastrectomy

Erdong Mao, Jinwei Yang, Bian Wu, Yun Shang†()   

  1. The second department of General Surgery, Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, China; The second department of General Surgery, The first People's Hospital of Yunnan Province, Kunming 650032, China
    The second department of General Surgery, The first People's Hospital of Yunnan Province, Kunming 650032, China; Institute of Neuroscience, Kunming Medical University, Kunming 650500, China
    The second department of General Surgery, The first People's Hospital of Yunnan Province, Kunming 650032, China
  • Received:2022-10-03 Published:2023-02-28
  • Corresponding author: Yun Shang
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毛尔东, 杨金伟, 吴边, 尚云. 腹腔镜袖状胃切除术后胃漏的研究进展及诊治体会[J]. 中华肥胖与代谢病电子杂志, 2023, 09(01): 55-61.

Erdong Mao, Jinwei Yang, Bian Wu, Yun Shang. Research progress and experience of diagnosis and treatment of gastric leakage after laparoscopic sleeve gastrectomy[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(01): 55-61.

腹腔镜袖状胃切除术（LSG）因具有相对简单的流程和确切的效果，已成为治疗肥胖症和2型糖尿病等代谢性疾病的重要手术方式。随着临床该术式的广泛开展，常见的胃漏、出血和狭窄梗阻等术后并发症被相继报道。胃漏一旦发生，如不及时诊断并采取迅速有效的治疗措施，往往导致住院时间延长、病情迁延不愈、治疗费用增加，甚至出现脓毒血症和多器官功能衰竭，导致患者死亡。笔者结合目前LSG术后胃漏的研究进展和团队实践经验，总结LSG术后胃漏的诊疗措施及治疗策略，希望为临床诊治提供一定的参考价值。

关键词: 腹腔镜袖状胃切除术, 胃漏, 诊治体会, 防治措施, 危险因素

Laparoscopic sleeve gastrectomy (LSG) is an crucial surgical procedure for treating metabolic diseases such as obesity and type 2 diabetes mellitus (T2DM) due to relatively simple procedure and definite effect. But, increasing complications, including gastric leakage, hemorrhage andstenosis, have been reported with widespread application. Especially the gastric leakage, unseasonal diagnosed and invalid treatment frequently results prolonged-hospital, protracted course of disease, more hospitalization expenses, or even sepsis, multiple systemic organ failure (MSOF) and death. Hereon, author summarized the diagnosis and treatment of gastric leakage after LSG derived from present research and team experience, and hope to provide worthy diagnosis and treatment.

Key words: Laparoscopic sleeve gastrectomy, Gastric leakage, Diagnosis and treatment experience, Prevention and control measures, Risk factor
表1 胃漏的分类
分类依据 分类 具体内容
病因 机械性胃漏 术后48~72 h内，主要由技术错误、钉仓选择不当、医源性损伤和远端梗阻等原因导致
  缺血性胃漏 术后5 d出现的胃漏
时间[16] 急性 术后1周内
  早期 术后1~6周
  晚期 术后6~12周
  慢性 术后12周后
位置[17,18] 近端①  
  中部  
  远端  
  胃后壁  
  无法定位  
临床及影像学表现[19,20] A型 无明显临床及影像学表现（微小漏口）
  B型 无明显临床表现但影像学检查确诊
  C型 明显临床表现及典型影像学特征
临床表现及扩散程度[21] Ⅰ型（亚临床型） 胃漏局限，无特殊临床及影像表现
  Ⅱ型（临床型） 胃漏扩散，引流管有造影剂甚至出现全身症状
特殊类型 胃胸腔漏 漏口与胸腔相通[22,23]
  胃皮肤漏 漏口与皮肤相通[24]
  胃结肠漏② 漏口与结肠相通
图1 LSG术后胃漏诊治流程图
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