减重手术围术期利拉鲁肽致术中反流及胃内容物残留1例

doi:10.3877/cma.j.issn.2095-9605.2026.01.011

近年来，随着胰高血糖素样肽-1受体激动剂（GLP-1RA）等新型减重药物的飞速发展，GLP-1RA被广泛应用于治疗肥胖症、2型糖尿病（T2DM）及多种代谢性疾病。目前，仅有数篇文献报告了围手术期使用GLP-1RA会增加术中反流、误吸的风险。本文报道1例术前禁食18 h以上，术中气管插管出现反流，术中探查胃内容物残留行保留胃底的腹腔镜袖状胃切除术（LSG），以期加强GLP-1RA围手术期的管理，降低围手术期的相关风险，规范行减重手术。

关键词: 利拉鲁肽, 减重手术, 袖状胃切除术, GLP-1RA, 术中反流, 胃内容物残留, 围手术期

In recent years, with the rapid development of novel anti-obesity medications such as glucagon-like peptide-1 receptor agonists (GLP-1RA), these agents have been extensively utilized in the treatment of obesity, type 2 diabetes mellitus (T2DM), and various metabolic disorders. Currently, only a limited number of published studies have reported an increased risk of intraoperative regurgitation and aspiration when GLP-1RA is administered in the perioperative period. This paper presents a case involving a patient who fasted for more than 18 hours prior to surgery, experienced regurgitation during tracheal intubation, and underwent laparoscopic sleeve gastrectomy (LSG) with preservation of the gastric fundus after intraoperative exploration revealed residual gastric contents. The aim of this report is to enhance the management of GLP-1RA in the perioperative period, reduce associated risks, and standardize the conduct of bariatric surgery.

Key words: Liraglutide, Bariatric surgery, Sleeve gastrectomy, GLP-1RA, Intraoperative reflux, Gastric contents retention, Perioperative period

图1 术中情况。A探查腹腔：见腹腔大量脂肪沉积，脂肪肝表现；B、C见胃底食物残留（图中箭头所示）；D残留胃底；E.胃底采用浆肌层包埋内翻缝合（图中箭头所示）；F放置腹腔引流管

图2 术前与术后CT对比A、B、C为术前CT；D、E、F为术后CT，残留胃底（图中箭头所示）

图3 A、B为患者术后1月上消化道造影，残留胃底（图中箭头所示）

表1 体重随访数据

随访时间(月)	体重/kg	减重/kg	BMI(kg/m²)	%TWl(%)	%EWL(%)
1	156.5	21.5	47.78	12.08	22.33
3	133	45	40.60	25.28	46.81
6	122	56	37.24	31.46	58.27
8	117	61	35.71	34.27	63.48

表1 体重随访数据

随访时间(月)	体重/kg	减重/kg	BMI(kg/m²)	%TWl(%)	%EWL(%)
1	156.5	21.5	47.78	12.08	22.33
3	133	45	40.60	25.28	46.81
6	122	56	37.24	31.46	58.27
8	117	61	35.71	34.27	63.48

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A case report of intraoperative reflux and gastric contents retention induced by Liraglutide during the perioperative period of bariatric surgery

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A case report of intraoperative reflux and gastric contents retention induced by Liraglutide during the perioperative period of bariatric surgery