腹腔镜袖状胃切除术联合胃底折叠术后胃漏1例诊疗体会

doi:10.3877/cma.j.issn.2095-9605.2024.01.010

胃漏是腹腔镜袖状胃切除术（LSG）联合胃底折叠术后最主要及最严重的并发症。本文报道1例内镜负压治疗LSG联合胃底折叠术后发生胃漏的病例。患者术前诊断为代谢综合征合并胃食管反流病（GERD），行LSG联合胃底折叠术，术后第10天因胃漏再次入院，行折叠瓣及漏口切除术。术后第5天再次发生胃漏，行内镜下负压装置及鼻-空肠营养管置入，术后予以肠内肠外营养，治疗过程中多次腹腔脓肿穿刺引流。术后2个月复查上腹部CT及上消化道造影，提示治愈。本病例提示我们对于有GERD的肥胖患者，LSG联合胃底折叠术的安全性需要进一步评估。对于术后发生胃漏的患者，内镜负压治疗操作简单安全，值得临床借鉴。

关键词: 袖状胃切除术, 胃底折叠术, 胃漏, 胃食管反流病, 内镜负压治疗

Gastric leakage is the most critical and severe complication after laparoscopic sleeve gastrectomy (LSG) combined with fundoplication. We aimed to report a case treated with endoscopic negative pressure therapy for gastric leakage after LSG combined with fundoplication. The patient was diagnosed with metabolic syndrome and gastroesophageal reflux disease (GERD) before surgery. The patient underwent LSG combined with fundoplication. The patient was readmitted to the hospital due to gastric leakage on postoperative day 10 and underwent fundoplication flap resection and leakage site resection. The patient was complicated with gastric leakage on postoperative day 5. Endoscopic negative pressure therapy and a nasojejunal feeding tube were inserted and given enteral and parenteral nutrition. Multiple abdominal punctures and drainage were performed during the whole treatment process. CT of the upper abdomen and gastric radiography identified a cure for the leakage 2 months after surgery. For obese patients with GERD, the safety of LSG combined with fundoplication needs to be further evaluated. For patients with postoperative gastric leakage, endoscopic negative pressure therapy is effective and safe, which is worthy of clinical reference.

Key words: Sleeve gastrectomy, Fundoplication, Gastric leakage, Gastroesophageal reflux disease, Endoscopic negative pressure therapy

图1 手术示意图。1A：保留部分胃底的袖状胃切除术；1B：胃底折叠术；1C：漏口位于胃底折叠瓣处（箭头所指处）

图2 患者腹腔镜下胃漏示意图。2A：漏口位于胃底折叠瓣处（箭头所指处）；2B：漏口处大量脓液

图3 手术切除折叠瓣及胃漏口。3A：切除折叠瓣及漏口；3B：加固缝合胃切缘

图4 患者第二次术后影像结果提示胃漏。4A：CT示胃切缘不完整（箭头所指处）；4B：上消化道造影示造影剂外溢（箭头所指处）

图5 负压装置制作示意图。5A：截取海绵；5B、5C：将海绵固定于胃管尖端

图6 负压装置置于胃漏口处进行持续引流。6A：内镜引导负压吸引装置；6B：通过胃镜将负压装置置于胃漏口处

图7 患者术后2个月影像结果提示胃漏愈合。7A：CT影像示胃切缘完整；7B：上消化道造影示无造影剂外溢

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Diagnosis and treatment experience of gastric leakage after laparoscopic sleeve gastrectomy combined with fundoplication

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Diagnosis and treatment experience of gastric leakage after laparoscopic sleeve gastrectomy combined with fundoplication