Mehran Amir, Szomstein Samuel, Zundel Nathan, Rosenthal Raul
The Bariatric Institute, Cleveland Clinic Florida, Weston, FL. USA.
Obes Surg. 2003 Dec;13(6):842-7. doi: 10.1381/096089203322618623.
The authors reviewed the incidence of hemorrhage after laparoscopic Roux-en-Y gastric bypass (LRYGBP). The purpose of this study was to determine the incidence of this complication and to evaluate various treatment options.
The records for 450 consecutive patients who had undergone LRYGBP over a 30-month period, were retrospectively reviewed. In all patients, the abdominal cavity had been drained with 2 19-Fr closed suction drains. The charts of patients who had developed an intraluminal or an intraabdominal bleed were chosen for further review.
20 patients (4.4%) developed an acute postoperative hemorrhage. The bleeding was intraluminal in 12 cases (60%), manifested by a drop in hematocrit, tachycardia and melena. The other 8 patients (40%) developed intra-abdominal hemorrhage, confirmed by large bloody output from the drains. 3 patients (15%) with intraluminal bleeding were unstable and required a reoperation. All others were successfully treated with observation, and 15 patients (75%) required blood transfusions.
The diagnosis and treatment of acute intraluminal bleeding after LRYGBP represents a surgical dilemma, mainly due to the inaccessibility of the bypassed stomach and the jejuno-jejunostomy, as well as the risks associated with early postoperative endoscopy. The presence of large intra-abdominal drains allows for bleeding site localization (intraluminal vs intraabdominal) and for more accurate monitoring of the bleeding rate. Most cases respond to conservative therapy. Failure of conservative management of intraluminal bleeding, however, is more problematic and may require operative intervention. A treatment algorithm is proposed.
作者回顾了腹腔镜Roux-en-Y胃旁路术（LRYGBP）后出血的发生率。本研究的目的是确定该并发症的发生率并评估各种治疗选择。
回顾性分析了在30个月内连续接受LRYGBP的450例患者的记录。所有患者的腹腔均用2根19F闭式吸引引流管进行引流。选择发生腔内或腹腔内出血的患者病历进行进一步复查。
20例患者（4.4%）发生急性术后出血。12例（60%）为腔内出血，表现为血细胞比容下降、心动过速和黑便。另外8例患者（40%）发生腹腔内出血，引流管引出大量血性液体证实了这一点。3例（15%）腔内出血患者病情不稳定，需要再次手术。其他所有患者经观察成功治疗，15例（75%）患者需要输血。
LRYGBP术后急性腔内出血的诊断和治疗是一个外科难题，主要原因是旁路胃和空肠-空肠吻合口难以接近，以及术后早期内镜检查存在风险。腹腔内留置大口径引流管有助于确定出血部位（腔内还是腹腔内），并更准确地监测出血速度。大多数病例对保守治疗有效。然而，腔内出血保守治疗失败的问题更大，可能需要手术干预。本文提出了一种治疗方案。
