减重代谢手术远期并发症预防及处理
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摘要
近年来,我国减重代谢手术发展迅速且术式不断改进。但术后并发症却并未因此减少,每一种新术式均会带来新的问题,新的减重中心的成立均可能带来新的考验。随着我国减重代谢手术术后随访时间的延长,一些远期并发症开始逐渐出现。减重代谢外科医生应更加重视术后并发症的预防,而只有对发展中遇到的问题进行分析解决才能有效预防术后并发症的发生。
In recent years,bariatric surgery has developed rapidly in China,and its surgical procedures are constantly being innovated. But the postoperative complications do not reduce. Each new kind of surgery brings new problems,and each new bariatric center established brings new test. Some long-term complications are emerging with the extension of time for bariatric postoperative follow-up in China. Metabolic surgeon should pay more attention to the prevention of postoperative complications. Only by analyzing and solving the developing problems can make postoperative complications be effectively prevented.
In recent years,bariatric surgery has developed rapidly in China,and its surgical procedures are constantly being innovated. But the postoperative complications do not reduce. Each new kind of surgery brings new problems,and each new bariatric center established brings new test. Some long-term complications are emerging with the extension of time for bariatric postoperative follow-up in China. Metabolic surgeon should pay more attention to the prevention of postoperative complications. Only by analyzing and solving the developing problems can make postoperative complications be effectively prevented.
引文
[1]王勇,王墨飞.腹腔镜胃袖状切除术后并发症防治策略[J].中国实用外科杂志,2017,27(4):382-385.
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[6]Rasmussen JJ,Fuller W,Ali MR.Marginal ulceration after laparoscopic gastric bypass:an analysis of predisposing factors in260 patients[J].Surg Endosc,2007,21(7):1090-1094.
[7]Edholm D,Sundbom M.Comparison between circular-and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass:A cohort from the Scandinavian Obesity Registry[J].Surg Obes Relat Dis,2015,11(6):1233-1236.
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[9]Patel RA,Brolin RE,Gandhi A.Revisional operations for marginal ulcer after Roux-en-Y gastric bypass[J].Surg Obes Relat Dis,2009,5(3):317-322.
[10]Konrad KW,Cheng Z,Mark D,et al.Modification of internal hernia classification system after laparoscopic Roux-en-Y bariatric surgery[J].Wideochir inne tech Maloinwazyjne,2015,2:197-204.
[11]Podnos,Yale D.Complications after laparoscopic gastric bypass[J].Arch Surg,2003,138(9):957.
[12]Steele KE,Prokopowicz GP,Magnuson T,et al.Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach[J].Surg Endosc,2008,22(9):2056-2061.
[13]Antanas M,Pratik S,Dugal H.Factors predicting the occurrence of a gastrojejunal anastomosis leak following gastric bypass[J].Wideochir Inne Tech Maloinwazyjne,2014,9(3):436-440.
[14]Grubnik VV,Grubnik AV,Vorotyntseva KO.Laparoscopic repair of incisional and ventral hernias with the new type of meshes:randomized control trial[J].Wideochir inne tech Maloinwazyjne,2014,9(2):145-151.
[15]Jr EG,Kuhn J,Arnold D,et al.Internal hernias after laparoscopic Roux-en-Y gastric bypass[J].Am J Surg,2004,188(6):796-800.
[16]Higa KD,Boone KB,Ho T.Complications of the laparoscopic Roux-en-Y gastric bypass:1,040 patients-what have we learned[J].Obes Surg,2000,10(6):509-513.
[17]Ackroyd R.Population-based study of the need for cholecystectomy after obesity surgery[J].Br J Surg,2012,99(6):864-869.
[18]Portenier DD,Grant JP,Blackwood HS,et al.Expectant management of the asymptomatic gallbladder at Roux-en-Y gastric bypass[J].Surg Obes Relat Dis,2007,3(4):476-479.
[19]Raziel A,Sakran N,Szold A,et al.Concomitant cholecystectomy during laparoscopic sleeve gastrectomy[J].Surg Endosc,2015,29(9):2789-2793.
[20]Monaco-Ferreira DV,Leandro-Merhi VA.Weight regain 10years after Roux-en-Y gastric bypass[J].Obes Surg,2017,27(5):1137-1144.
[21]Sj?str?m L,Lindroos AK,Peltonen M,et al.Lifestyle,diabetes,and cardiovascular risk factors 10 years after bariatric surgery[J].NEJM,2004,351(26):2683-2693.
[22]Hammer,Heinz F.Medical complications of bariatric surgery:focus on malabsorption and dumping syndrome[J].Digest Dis,2012,30(2):182-186.
[23]Levinson R,Silverman J,Catella J,et al.Pharmacotherapy prevention and management of nutritional deficiencies post Rouxen-Y gastric bypass[J].Obes Surg,2013,23(7):992-1000.
[24]Fabrizio R,Allaix ME,Claudio G,et al.Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy:A physiopathologic evaluation[J].Ann Surg,2014,260(5):909-915.
[25]Tai CM,Huang CK.Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults[J].Surg Endosc,2013,27(10):3937-3937.
[26]Carter PR,Leblanc KA,Hausmann MG,et al.Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy[J].Surg Obes Relat Dis,2011,7(5):569-572.
[27]Rawlins L,Rawlins MP,Brown CC,et al.Sleeve gastrectomy:5-year outcomes of a single institution[J].Surg Obes Relat Dis,2013,9(1):21-25.
[28]Weiner RA,Weiner S,Pomhoff I,et al.Laparoscopic sleeve gastrectomy influence of sleeve size and resected gastric volume[J].Obes Surg,2007,17(10):1297-1305.
[29]Nadaleto BF,Herbella FAM,Patti MG.Gastroesophageal reflux disease in the obese:Pathophysiology and treatment[J].Surgery,2016,159(2):475-486.
[30]Chang P,Friedenberg F.Obesity and GERD[J].Gastroenterol Clin North Am,2014,43(1):161-173.
[31]Mattar SG,Qureshi F,Taylor D,et al.Treatment of refractory gastroesophageal reflux disease with radiofrequency energy(Stretta)in patients after Roux-en-Y gastric bypass[J].Surg Endosc,2006,20(6):850-854.
[32]Nelson DW,Blair KS,Martin MJ.Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity[J].Arch Surg,2012,147(9):847-854.
[33]Puli SR,Spofford IS,Thompson CC.Use of self-expandable stents in the treatment of bariatric surgery leaks:A systematic review and meta-analysis[J].Gastrointest Endosc,2012,75(2):287-293.
[34]Santry HP,Gillen DL,Lauderdale DS.Trends in bariatric surgical procedures[J].JAMA,2005,294(15):1909-1917.
[35]Nienhuijs SW,Kaymak U,Korsten E,et al.Influence of intraoperative hypotension on leaks after sleeve gastrectomy[J].Surg Obes Relat Dis,2016,12(3):535-539.
[36]Siilin H,Wanders A,Gustavsson S,et al.The proximal gastric pouch invariably contains acid-producing parietal cells in Roux-en-Y gastric bypass[J].Obes Surg,2005,15(6):771-777.
[2]Doumouras AG,Saleh F,Gmora S,et al.The value of surgical experience:excess costs associated with the Roux-en-Y gastric bypass learning curve[J].Surg Endosc,2018 Sep 24.
[3]秦新裕,吴海福,刘凤林.积极稳妥开展2型糖尿病外科治疗几点意见和建议[J].中国实用外科杂志,2014,34(11):1018-1020.
[4]Müller S,Runkel N.Stenosis and ulceration after bariatric surgery[J].Chirurg,2015,86(9):841-846.
[5]Azagury DE,Dayyeh BKA,Greenwalt IT,et al.T1055 Marginal ulcers after Roux-en-Y gastric bypass surgery:risk factors,treatment and outcomes[J].Endoscopy,2011,43(11):950-954.
[6]Rasmussen JJ,Fuller W,Ali MR.Marginal ulceration after laparoscopic gastric bypass:an analysis of predisposing factors in260 patients[J].Surg Endosc,2007,21(7):1090-1094.
[7]Edholm D,Sundbom M.Comparison between circular-and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass:A cohort from the Scandinavian Obesity Registry[J].Surg Obes Relat Dis,2015,11(6):1233-1236.
[8]Sacks BC,Mattar SG,Qureshi FG,et al.Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass[J].Surg Obes Relat Dis,2006,2(1):11-16.
[9]Patel RA,Brolin RE,Gandhi A.Revisional operations for marginal ulcer after Roux-en-Y gastric bypass[J].Surg Obes Relat Dis,2009,5(3):317-322.
[10]Konrad KW,Cheng Z,Mark D,et al.Modification of internal hernia classification system after laparoscopic Roux-en-Y bariatric surgery[J].Wideochir inne tech Maloinwazyjne,2015,2:197-204.
[11]Podnos,Yale D.Complications after laparoscopic gastric bypass[J].Arch Surg,2003,138(9):957.
[12]Steele KE,Prokopowicz GP,Magnuson T,et al.Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach[J].Surg Endosc,2008,22(9):2056-2061.
[13]Antanas M,Pratik S,Dugal H.Factors predicting the occurrence of a gastrojejunal anastomosis leak following gastric bypass[J].Wideochir Inne Tech Maloinwazyjne,2014,9(3):436-440.
[14]Grubnik VV,Grubnik AV,Vorotyntseva KO.Laparoscopic repair of incisional and ventral hernias with the new type of meshes:randomized control trial[J].Wideochir inne tech Maloinwazyjne,2014,9(2):145-151.
[15]Jr EG,Kuhn J,Arnold D,et al.Internal hernias after laparoscopic Roux-en-Y gastric bypass[J].Am J Surg,2004,188(6):796-800.
[16]Higa KD,Boone KB,Ho T.Complications of the laparoscopic Roux-en-Y gastric bypass:1,040 patients-what have we learned[J].Obes Surg,2000,10(6):509-513.
[17]Ackroyd R.Population-based study of the need for cholecystectomy after obesity surgery[J].Br J Surg,2012,99(6):864-869.
[18]Portenier DD,Grant JP,Blackwood HS,et al.Expectant management of the asymptomatic gallbladder at Roux-en-Y gastric bypass[J].Surg Obes Relat Dis,2007,3(4):476-479.
[19]Raziel A,Sakran N,Szold A,et al.Concomitant cholecystectomy during laparoscopic sleeve gastrectomy[J].Surg Endosc,2015,29(9):2789-2793.
[20]Monaco-Ferreira DV,Leandro-Merhi VA.Weight regain 10years after Roux-en-Y gastric bypass[J].Obes Surg,2017,27(5):1137-1144.
[21]Sj?str?m L,Lindroos AK,Peltonen M,et al.Lifestyle,diabetes,and cardiovascular risk factors 10 years after bariatric surgery[J].NEJM,2004,351(26):2683-2693.
[22]Hammer,Heinz F.Medical complications of bariatric surgery:focus on malabsorption and dumping syndrome[J].Digest Dis,2012,30(2):182-186.
[23]Levinson R,Silverman J,Catella J,et al.Pharmacotherapy prevention and management of nutritional deficiencies post Rouxen-Y gastric bypass[J].Obes Surg,2013,23(7):992-1000.
[24]Fabrizio R,Allaix ME,Claudio G,et al.Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy:A physiopathologic evaluation[J].Ann Surg,2014,260(5):909-915.
[25]Tai CM,Huang CK.Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults[J].Surg Endosc,2013,27(10):3937-3937.
[26]Carter PR,Leblanc KA,Hausmann MG,et al.Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy[J].Surg Obes Relat Dis,2011,7(5):569-572.
[27]Rawlins L,Rawlins MP,Brown CC,et al.Sleeve gastrectomy:5-year outcomes of a single institution[J].Surg Obes Relat Dis,2013,9(1):21-25.
[28]Weiner RA,Weiner S,Pomhoff I,et al.Laparoscopic sleeve gastrectomy influence of sleeve size and resected gastric volume[J].Obes Surg,2007,17(10):1297-1305.
[29]Nadaleto BF,Herbella FAM,Patti MG.Gastroesophageal reflux disease in the obese:Pathophysiology and treatment[J].Surgery,2016,159(2):475-486.
[30]Chang P,Friedenberg F.Obesity and GERD[J].Gastroenterol Clin North Am,2014,43(1):161-173.
[31]Mattar SG,Qureshi F,Taylor D,et al.Treatment of refractory gastroesophageal reflux disease with radiofrequency energy(Stretta)in patients after Roux-en-Y gastric bypass[J].Surg Endosc,2006,20(6):850-854.
[32]Nelson DW,Blair KS,Martin MJ.Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity[J].Arch Surg,2012,147(9):847-854.
[33]Puli SR,Spofford IS,Thompson CC.Use of self-expandable stents in the treatment of bariatric surgery leaks:A systematic review and meta-analysis[J].Gastrointest Endosc,2012,75(2):287-293.
[34]Santry HP,Gillen DL,Lauderdale DS.Trends in bariatric surgical procedures[J].JAMA,2005,294(15):1909-1917.
[35]Nienhuijs SW,Kaymak U,Korsten E,et al.Influence of intraoperative hypotension on leaks after sleeve gastrectomy[J].Surg Obes Relat Dis,2016,12(3):535-539.
[36]Siilin H,Wanders A,Gustavsson S,et al.The proximal gastric pouch invariably contains acid-producing parietal cells in Roux-en-Y gastric bypass[J].Obes Surg,2005,15(6):771-777.