腹腔镜Roux-en-Y胃旁路术后常规上消化道泛影葡胺吞咽造影检查。

Routine upper gastrointestinal Gastrografin swallow after laparoscopic Roux-en-Y gastric bypass.

作者信息

Sims Thomas L, Mullican Mary A, Hamilton Elizabeth C, Provost David A, Jones Daniel B

机构信息

Southwestern Center for Surgery for Obesity, Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235-9092, USA.

出版信息

Obes Surg. 2003 Feb;13(1):66-72. doi: 10.1381/096089203321136610.

DOI:10.1381/096089203321136610

PMID:12630616

Abstract

BACKGROUND

Upper gastrointestinal (UGI) swallow radiographs following laparoscopic Roux-en-Y gastric bypass (LRYGBP) may detect an obstruction or an anastomotic leak. The aim of our study was to determine the efficacy of routine imaging following LRYGBP.

METHODS

Radiograph reports were reviewed for 201 consecutive LRYGBP operations between April 1999 and June 2001. UGI swallow used Gastrografin, static films, fluoroscopic video, and a delayed image at 10 minutes. Mean values with one standard deviation were tested for significance (P < 0.05) using the Mann-Whitney U test statistic.

RESULTS

Of 198 available reports, UGI detected jejunal efferent (Roux) limb narrowing (n = 17), partial obstruction (n = 12), anastomotic leak (n = 3), complete bowel obstruction (n = 3), diverticulum (n = 1), hiatal hernia (n = 1), and proximal Roux limb narrowing (n = 1). A normal study was reported in 160 cases (81%). Partial obstruction resolved without intervention. Complete obstruction required re-operation. Compared to 6 patients who developed delayed leaks, early identification of a leak by routine UGI swallow resulted in a shorter hospital stay (mean 7.7 +/- 1.5 days vs 40.2 +/- 12.3 days, P < 0.03).

CONCLUSIONS

Early intervention after UGI swallow may lessen morbidity. Routine UGI swallow following LRYGBP does not obviate the importance of close clinical follow-up.

摘要

背景

腹腔镜Roux-en-Y胃旁路术（LRYGBP）后进行上消化道（UGI）吞咽造影检查可检测出梗阻或吻合口漏。我们研究的目的是确定LRYGBP术后常规成像的效果。

方法

回顾了1999年4月至2001年6月期间连续201例LRYGBP手术的造影报告。UGI吞咽造影使用泛影葡胺、静态片、荧光透视视频以及10分钟后的延迟图像。使用Mann-Whitney U检验统计量对均值加一个标准差进行显著性检验（P < 0.05）。

结果

在198份可用报告中，UGI检测出空肠输出袢（Roux袢）狭窄（n = 17）、部分梗阻（n = 12）、吻合口漏（n = 3）、完全性肠梗阻（n = 3）、憩室（n = 1）、食管裂孔疝（n = 1）以及近端Roux袢狭窄（n = 1）。160例（81%）报告结果正常。部分梗阻未经干预自行缓解。完全性梗阻需要再次手术。与6例出现延迟漏的患者相比，通过常规UGI吞咽造影早期发现漏可缩短住院时间（平均7.7 +/- 1.5天对40.2 +/- 12.3天，P < 0.03）。