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 ›› 2023, Vol. 09 ›› Issue (01) : 62 -67. doi: 10.3877/cma.j.issn.2095-9605.2023.01.012

病例报告

胃束带侵蚀致复杂食道及胃瘘的处理——一例病例报告及文献回顾
赵稳, 刘浩, 武现生, 金露佳, 陈鹏, 李丁昌, 高文星, 刘先强, 董光龙()   
  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:2023-01-03 出版日期:2023-02-28
  • 通信作者: 董光龙

Management of esophagogastric fistula caused by adjustable gastric band erosion: a case report and literature review

Wen Zhao, Hao Liu, Xiansheng Wu, Lujia Jin, Peng Chen, Dingchang Li, Wenxing Gao, Xiangqiang Liu, Guanglong Dong()   

  1. Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2023-01-03 Published:2023-02-28
  • Corresponding author: Guanglong Dong
引用本文:

赵稳, 刘浩, 武现生, 金露佳, 陈鹏, 李丁昌, 高文星, 刘先强, 董光龙. 胃束带侵蚀致复杂食道及胃瘘的处理——一例病例报告及文献回顾[J]. 中华肥胖与代谢病电子杂志, 2023, 09(01): 62-67.

Wen Zhao, Hao Liu, Xiansheng Wu, Lujia Jin, Peng Chen, Dingchang Li, Wenxing Gao, Xiangqiang Liu, Guanglong Dong. Management of esophagogastric fistula caused by adjustable gastric band erosion: a case report and literature review[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(01): 62-67.

食道下端及胃瘘是腹腔镜可调节胃束带术(LAGB)术后最严重的并发症之一。因病情复杂,处理不当可致胸腹腔感染、败血症等严重后果。对于这类严重的束带术后并发症,目前国内外未见报道。本文报道多学科、分阶段成功治疗一例LAGB术后12年胃束带侵蚀致复杂食道–胃瘘的病例,旨在为束带术后的这一严重并发症的治疗提供一定的借鉴。

Lower esophageal and gastric fistula is a rare but dangerous complication after laparoscopic adjustable gastric band (LAGB). If the complication was handled clumsily, it could lead to serious consequences such as thoracoabdominal infection and sepsis.Owing to its low prevalence and complexity, to our knowledge, cases of esophagogastric fistula caused by gastric band erosion after LAGB have not been reported. We present our experience with a case of esophagogastric fistula occurring twelve years after a laparoscopic band procedure, and its successful management in a multidisciplinary and staged manner.

图1 患者术前检查结果。1A:(术前胃镜)食道-贲门口处有一片状黑色物,另见一长约4 cm,宽约1.5 cm条形异物,一段插入胃壁;1B:(术前CT)束带位于贲门胃底部,部分位于胃腔内
图2 患者术中情况。2A:束带侵蚀食道–胃前壁处有一大小约2 cm×2 cm瘘口;2B:2-0可吸收线间断缝合食道-胃前壁瘘口
图3 患者术后腹部引流管分布图。分别于左上腹和右上腹放置双套腹腔引流管至瘘口周围
图4 患者术后1周胃镜检查结果。食道下段–贲门胃底后壁有一瘘口及较深脓腔,可见缝合线
图5 患者术后6周胃镜检查结果。食道下段–贲门胃底后壁瘘口未完全闭合,注入医用生物蛋白胶封堵
图6 患者术后10周胃镜检查结果。6A:引流管注入美蓝后,可见食道–贲门后壁有一极细小的瘘口溢出少量美蓝,予以止血夹夹闭;6B:可见瘘口约5 mm,注入医用生物蛋白胶封堵
图7 患者术后12周胃镜检查结果。瘘口明显变小,约2 mm,同时注入医用生物蛋白胶封堵
图8 患者出院3周后胃镜检查结果。瘘口已愈合,给予胃造瘘管拔出联合胃造瘘口止血夹夹闭
[1]
Snyder B, Wilson T, Mehta S, et al. Past, present, and future: Critical analysis of use of gastric bands in obese patients [J]. Diabetes Metab Syndr Obes, 2010, 3:55-65.
[2]
Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial [J]. Surg Obes Relat Dis, 2007, 3(2): 127-132.
[3]
Falk V, Sheppard C, Kanji A, et al. The fate of laparoscopic adjustable gastric band removal [J]. Can J Surg, 2019, 62(5): 328-333.
[4]
Di Lorenzo N, Lorenzo M, Furbetta F, et al. Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients [J]. Surg Endosc, 2013, 27(4): 1151-1157.
[5]
Jaber J, Glenn J, Podkameni D, et al. A 5-Year History of Laparoscopic Gastric Band Removals: an Analysis of Complications and Associated Comorbidities [J]. Obes Surg, 2019, 29(4): 1202-1206.
[6]
Kuzmak LI. A Review of Seven Years' Experience with Silicone Gastric Banding [J]. Obes Surg, 1991, 1(4): 403-408.
[7]
Belachew M, Belva PH, Desaive C. Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity [J]. Obes Surg, 2002, 12(4): 564-568.
[8]
Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants [J]. Lancet, 2021, 397(10287): 1830-1841.
[9]
Girardi V, Barone G, Gualtierotti M, et al. Laparoscopic Adjustable Gastric Band: Case Report of Erosion with Intragastric Migration Requiring an Extreme Surgical Approach [J]. Obes Surg, 2020, 30(5): 2030-2032.
[10]
Garrido D, Bush LM. Liver abscess as a complication of laparoscopic gastric banding bariatric surgery [J]. Surg Infect (Larchmt), 2013, 14(5): 464-469.
[11]
Neto MP, Ramos AC, Campos JM, et al. Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases [J]. Surg Obes Relat Dis, 2010, 6(4): 423-427.
[12]
Singhal R, Bryant C, Kitchen M, et al. Band slippage and erosion after laparoscopic gastric banding: a meta-analysis [J]. Surg Endosc, 2010, 24(12): 2980-2986.
[13]
Yoon CI, Pak KH, Kim SM. Early experience with diagnosis and management of eroded gastric bands [J]. J Korean Surg Soc, 2012, 82(1): 18-27.
[14]
Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review [J]. Surgery, 2004, 135(3): 326-351.
[15]
Spivak H, Favretti F. Avoiding postoperative complications with the LAP-BAND system [J]. Am J Surg, 2002, 184(6B): 31S-37S.
[16]
Martines G, Picciariello A, Ugenti I, et al. Laparoscopic adjustable gastric banding migration: an early approach for a late complication [J]. G Chir, 2017, 38(5): 225-228.
[17]
Rudd AA, Lall C, Deodhar A, et al. Gastropericardial Fistula as a Late Complication of Laparoscopic Gastric Banding [J]. J Clin Imaging Sci, 2017, 7:3.
[18]
Spann MD, Aher CV, English WJ, et al. Endoscopic management of erosion after banded bariatric procedures [J]. Surg Obes Relat Dis, 2017, 13(11): 1875-1879.
[19]
Quadri P, Gonzalez-Heredia R, Masrur M, et al. Management of laparoscopic adjustable gastric band erosion [J]. Surg Endosc, 2017, 31(4): 1505-1512.
[20]
Borao FJ, Steven JB, Gurdeep SM. Revisional foregut surgery [M]. Springer Nature, 2019.
[21]
Parodi A, Repici A, Pedroni A, et al. Endoscopic management of GI perforations with a new over-the-scope clip device (with videos) [J]. Gastrointest Endosc, 2010, 72(4): 881-886.
[22]
Keren D, Eyal O, Sroka G, et al. Over-the-Scope Clip (OTSC) System for Sleeve Gastrectomy Leaks [J]. Obes Surg, 2015, 25(8): 1358-1363.
[23]
Bège T, Emungania O, Vitton V, et al. An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study [J]. Gastrointest Endosc, 2011, 73(2): 238-244.
[24]
Walsh C, Karmali S. Endoscopic management of bariatric complications: A review and update [J]. World J Gastrointest Endosc, 2015, 7(5): 518-523.
[25]
Jain R, Wairkar S. Recent developments and clinical applications of surgical glues: An overview [J]. Int J Biol Macromol, 2019, 137: 95-106.
[1] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[2] 康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[3] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[4] 张钊, 骆成玉, 张树琦, 何平, 李旭斌. 不同术式治疗早期乳腺癌的效果及并发症发生率、复发率比较[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 494-497.
[5] 曾繁利, 齐秩凯, 杨贺庆. 两种经Glisson蒂鞘解剖路径肝切除术治疗原发性肝癌的肿瘤学疗效及风险比对[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 525-527.
[6] 向辉, 贾晓斌, 全卫涛. 真空辅助乳腺微创旋切术治疗乳腺纤维瘤的效果及并发症观察[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 528-530.
[7] 王维花, 王楠, 乔庆, 罗红. 完全腹腔镜右半结肠癌切除术两种腔内消化道重建方案对比研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 574-577.
[8] 吉顺富, 汤晓燕, 徐进. 腹腔镜近端胃癌根治术中拓展胃后间隙在肥胖患者中的应用研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 393-396.
[9] 刘娟娟, 李志华. 风险预警对无创呼吸机治疗肺心病并发呼吸衰竭的作用[J]. 中华肺部疾病杂志(电子版), 2024, 17(04): 645-647.
[10] 李澄清, 郭文毅, 王磊. 腹腔镜保留脾脏胰体尾切除术:微创胰腺外科的合理决策[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 620-624.
[11] 罗柳平, 吴萌萌, 陈欣磊, 林科灿. 胰腺全系膜切除在胰头癌根治术中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 651-656.
[12] 韩青雷, 丛赟, 李佳隆, 邵英梅. 术前减黄方式对壶腹周围癌胰十二指肠切除术后并发症的影响[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 665-669.
[13] 冀旭, 朱峰, 冯业晨. 保留器官功能的胰腺切除术后胆道并发症发生危险因素分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 509-514.
[14] 陈先志, 许磊, 冯其柱, 王琦. 布地奈德联合复方异丙托溴铵雾化吸入在老年患者腹腔镜围手术期中的应用[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 531-536.
[15] 王璇, 娜扎开提·尼加提, 雒洋洋, 蒋升. 皮肤晚期糖基化终末产物浓度与2型糖尿病微血管并发症的相关性[J]. 中华临床医师杂志(电子版), 2024, 18(05): 447-454.
阅读次数
全文


摘要