腹腔镜Roux-en-Y胃旁路术治疗病态肥胖后渗漏的临床预测因素
Clinical predictors of leak after laparoscopic Roux-en-Y gastric bypass for morbid obesity.
作者信息
Hamilton E C, Sims T L, Hamilton T T, Mullican M A, Jones D B, Provost D A
机构信息
Clinical Center for the Surgical Management of Obesity and the Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, Dallas, 75390, USA.
出版信息
Surg Endosc. 2003 May;17(5):679-84. doi: 10.1007/s00464-002-8819-5. Epub 2003 Mar 7.
BACKGROUND
Gastrointestinal leak is a complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Contrast studies may underdiagnose leaks, forcing surgeons to rely solely on clinical data. This study was designed to evaluate various clinical signs for detecting leakage after LRYGB.
METHODS
We retrospectively reviewed 210 consecutive patients who underwent LRYGB between April 1999 and September 2001. There were nine documented leaks (4.3%). Clinical signs between patients with leaks (group 1) and those without leaks (group 2) were compared using univariate and multivariate logistic regression analysis.
RESULTS
Evidence of respiratory distress and a heart rate exceeding 120 beats per min were the two most sensitive indicators of gastrointestinal leak. Routine upper gastrointestinal contrast imaging detected only two of nine leaks (22%).
CONCLUSION
Leak after LRYGB may be difficult to detect. Evidence of respiratory distress and tachycardia exceeding 120 beats per min may be the most useful clinical indicators of leak after laparoscopic Roux-en-Y gastric bypass.
背景
胃肠道漏是腹腔镜Roux - Y胃旁路术（LRYGB）的一种并发症。造影检查可能会漏诊胃肠道漏，这使得外科医生只能完全依赖临床数据。本研究旨在评估用于检测LRYGB术后渗漏的各种临床体征。
方法
我们回顾性分析了1999年4月至2001年9月期间连续接受LRYGB手术的210例患者。记录到9例渗漏（4.3%）。采用单因素和多因素逻辑回归分析比较渗漏患者（第1组）和无渗漏患者（第2组）的临床体征。
结果
呼吸窘迫和心率超过120次/分钟是胃肠道漏的两个最敏感指标。常规上消化道造影检查仅检测出9例渗漏中的2例（22%）。
结论
LRYGB术后的渗漏可能难以检测。呼吸窘迫和心动过速超过120次/分钟可能是腹腔镜Roux - Y胃旁路术后渗漏最有用的临床指标。
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