Carucci Laura R, Turner Mary Ann, Conklin Robert C, DeMaria Eric J, Kellum John M, Sugerman Harvey J
Department of Radiology, Virginia Commonwealth University Medical Center, PO Box 980615, Richmond, VA 23298-0615, USA.
Radiology. 2006 Jan;238(1):119-27. doi: 10.1148/radiol.2381041557.
To retrospectively evaluate the radiographic features of extraluminal leak after Roux-en-Y gastric bypass (RYGBP) surgery at upper gastrointestinal (GI) examinations in a large series of patients and to determine morbidity and mortality in those patients with leak.
The investigational review board approved this HIPAA-compliant study, and the need for patient informed consent was waived. Radiologic database review revealed 1202 upper GI studies performed over a 4-year period in 906 patients after RYGBP. Extraluminal leak was identified in 50 patients. Two patients with leaks that occurred before the study period were excluded. Of the remaining 48 patients, 12 were men and 36 were women (mean age, 45 years; range, 26-64 years). Surgery had been laparoscopic in 23 patients and open in 25. Upper GI studies were analyzed by two radiologists in consensus for the origin, extent, and severity of leaks and associated findings. Chart review was performed to determine clinical course, treatment, and outcome.
Fifty extraluminal leaks were detected in 48 of 904 patients (5.3%) at upper GI examinations. All leaks were identified within 28 days, and, in 37 of 48 patients (77%), leakage was diagnosed within 1 week of surgery. The majority of leaks (n = 37) originated from the gastrojejunal anastomosis. Leaks also occurred at the distal portion of the esophagus (n = 5), the gastric pouch (n = 5), the oversewn jejunum (n = 2), and the distal anastomosis (n = 1). Leaks extended into the left upper quadrant in 30 patients. Obstruction or ileus was present in 35 of 48 patients (73%). Leak into the excluded stomach was observed in 15 of 48 patients. The occurrence of extraluminal leak prolonged hospital stays; organ failure occurred in 14 (29%) and death in three (6%) of the 48 patients.
Extraluminal leak was identified on upper GI series in 48 of 904 patients (5.3%) after RYGBP for morbid obesity. Extraluminal leak most commonly arises from the gastrojejunal anastomosis and extends into the left upper quadrant. Extraluminal leak affects morbidity and mortality.
回顾性评估大量患者在接受Roux-en-Y胃旁路术（RYGBP）后上消化道（GI）检查时腔外渗漏的影像学特征，并确定发生渗漏患者的发病率和死亡率。
研究审查委员会批准了这项符合HIPAA的研究，且无需患者知情同意。放射学数据库回顾显示，906例患者在接受RYGBP术后4年期间进行了1202次上消化道检查。50例患者发现有腔外渗漏。排除2例在研究期之前发生渗漏的患者。其余48例患者中，男性12例，女性36例（平均年龄45岁；范围26 - 64岁）。23例患者手术为腹腔镜手术，25例为开放手术。两名放射科医生共同分析上消化道检查结果，以确定渗漏的起源、范围、严重程度及相关表现。进行病历审查以确定临床病程、治疗及结局。
904例患者中有48例（5.3%）在上消化道检查时发现50处腔外渗漏。所有渗漏均在28天内发现，48例患者中有37例（77%）在术后1周内确诊渗漏。大多数渗漏（n = 37）起源于胃空肠吻合口。渗漏也发生在食管远端（n = 5）、胃小囊（n = 5）、缝合的空肠（n = 2）和远端吻合口（n = 1）。30例患者的渗漏延伸至左上腹。48例患者中有35例（73%）出现梗阻或肠梗阻。48例患者中有15例观察到渗漏进入旷置胃。腔外渗漏的发生延长了住院时间；48例患者中有14例（29%）发生器官衰竭，3例（6%）死亡。
在接受RYGBP治疗病态肥胖的904例患者中，48例（5.3%）在上消化道造影中发现腔外渗漏。腔外渗漏最常见于胃空肠吻合口，并延伸至左上腹。腔外渗漏影响发病率和死亡率。
