胃袖状切除术后袖状胃胸腔内上移的原因与防治
Causes and prevention of gastric migration into the thorax after sleeve gastrectomy
江云颂 1杨景哥1
作者信息
- 1. 暨南大学附属第一医院胃肠外科,广东广州 510630
- 折叠
摘要
袖状胃胸腔内上移(ITSM)是腹腔镜胃袖状切除术(LSG)后潜在的并发症,与中心性肥胖、胃食管反流病、手术操作、术后体重下降等因素有关.通过CT、食管胃十二指肠镜、上消化道造影等相关检查,可辅助诊断.LSG同期对食管裂孔疝修补是预防ITSM的关键.急性ITSM易造成嵌顿等严重后果,需迅速干预,而术后远期ITSM影响生活质量,也需手术干预.对于有ITSM高复发风险的病人,如较大食管裂孔缺陷、胃狭窄等病人,若无Roux-en-Y胃旁路术(RYGB)禁忌证且能接受手术风险,建议修正为RYGB,并结合其他手术降低复发风险.
Abstract
Intra-thoracic sleeve migration(ITSM)is a potential complication after laparoscopic sleeve gastrectomy(LSG)and is related to central obesity,gastroesophageal reflux disease,surgical procedures,postoperative weight loss,and other factors.The auxiliary diagnosis can be done by computed tomography(CT),esophagogastroduodenoscopy,upper gastrointestinal imaging,and other related examinations.Repairing esophageal hiatus hernia during LSG is the key to preventing ITSM.Acute ITSM is prone to cause serious consequences such as incarceration,requiring rapid intervention,while long-term ITSM after surgery affects the quality of life and also requires surgical intervention.For patients with a high risk of recurrences,such as large hiatal hernia(HH)defects and gastric stenosis,if there are no contraindications to Roux-en-Y gastric bypass(RYGB)when they can accept the risk of surgery,modifying it to RYGB is recommended,and combining with other surgeries to reduce the risk of recurrence.
关键词
减重代谢手术/腹腔镜胃袖状切除术/袖状胃胸腔内上移/肥胖症Key words
bariatric and metabolic surgery/laparoscopic sleeve gastrectomy/intra-thoracic sleeve migration/obesity引用本文复制引用
基金项目
广州市科技计划项目基础与应用基础研究项目(2024A03J1259)
广州市科技计划市校院联合资助项目(202201020064)
出版年
2024
国家科技期刊平台
NSTL
万方数据