Nguyen Ninh T, Longoria Mario, Welbourne Susan, Sabio Allen, Wilson Samuel E
Department of Surgery, Division of Gastrointestinal Surgery, University of California-Irvine Medical Center, 101 The City Drive, Orange, CA 92868, USA.
Arch Surg. 2005 Aug;140(8):773-8. doi: 10.1001/archsurg.140.8.773.
The use of staple-line reinforcement sleeves during laparoscopic gastric bypass reduces staple-line bleeding, which may translate into a reduction in the rate of gastrointestinal hemorrhage.
Prospective randomized trial.
University hospital.
Thirty-four patients undergoing laparoscopic gastric bypass were randomly assigned to receive either no reinforcement (control group, n = 17) or reinforcement of the staple line with glycolic copolymer sleeves (treatment group, n = 17).
Demographic data, the number of stapler loads used, the number of staple-line bleeding sites, the amount of blood loss, the length of time required to obtain hemostasis of the staple lines, operative time, intraoperative and postoperative complications, and serial hemoglobin levels.
The mean number of stapler loads used was similar between groups. The mean number of staple-line bleeding sites was significantly fewer in the treatment group for division of gastric tissue (0.4 vs 2.5 bleeding sites), jejunal tissue (0.1 vs 0.6 bleeding site), and mesenteric tissue (0 vs 0.8 bleeding site). The mean blood loss was lower in the treatment group (84 vs 129 mL). Staple misfire occurred in 1 (0.7%) of 143 stapler loads used in the treatment group compared with 0 (0%) of 138 stapler loads used in the control group. The time to obtain staple-line hemostasis was shorter in the treatment group (1.2 vs 10.1 minutes). The total operative time was similar between groups. There was no mortality or postoperative leaks. One patient in the control group had postoperative gastrointestinal hemorrhage requiring blood transfusion and reoperation. There was no significant difference in the mean hemoglobin level between groups on the first postoperative day.
The use of glycolide copolymer staple-line reinforcement sleeves in patients undergoing laparoscopic gastric bypass is safe and significantly reduces staple-line bleeding sites and may reduce the incidence of gastrointestinal hemorrhage.
在腹腔镜胃旁路手术中使用吻合口加固套可减少吻合口出血，这可能转化为胃肠道出血率的降低。
前瞻性随机试验。
大学医院。
34例行腹腔镜胃旁路手术的患者被随机分配，分别接受不进行加固（对照组，n = 17）或用乙醇酸共聚物套加固吻合口（治疗组，n = 17）。
人口统计学数据、使用的吻合器钉仓数量、吻合口出血部位数量、失血量、吻合口止血所需时间、手术时间、术中和术后并发症以及连续血红蛋白水平。
两组使用的吻合器钉仓平均数量相似。在胃组织离断（0.4个出血部位对2.5个出血部位）、空肠组织离断（0.1个出血部位对0.6个出血部位）和肠系膜组织离断（0个出血部位对0.8个出血部位）方面，治疗组吻合口出血部位的平均数量显著更少。治疗组的平均失血量更低（84毫升对129毫升）。治疗组使用的143个吻合器钉仓中有1个（0.7%）发生吻合器击发失败，而对照组使用的138个吻合器钉仓中有0个（0%）发生。治疗组获得吻合口止血的时间更短（1.2分钟对10.1分钟）。两组的总手术时间相似。无死亡或术后吻合口漏。对照组有1例患者术后发生胃肠道出血，需要输血和再次手术。术后第一天两组的平均血红蛋白水平无显著差异。
在接受腹腔镜胃旁路手术的患者中使用乙交酯共聚物吻合口加固套是安全的，可显著减少吻合口出血部位，并可能降低胃肠道出血的发生率。
