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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
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