Gould Jon Charles, Garren Michael, Boll Valerie, Starling James
Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, K4/762 Clinical Science Center, Madison, WI 53792-7375, USA.
Surg Endosc. 2006 Jul;20(7):1017-20. doi: 10.1007/s00464-005-0207-5. Epub 2006 Jun 8.
Gastrojejunostomy stenosis after laparoscopic Roux-en-Y gastric bypass is a common occurrence. The incidence varies widely among reported series. We evaluated the impact of circular stapler size on the rate of stenosis and weight loss.
Our initial technique utilized a 21-mm circular stapler to construct the gastrojejunostomy. We switched to a 25-mm stapler after a large preliminary experience. Stenosis was confirmed by endoscopy in patients complaining of the inability to eat or excessive vomiting, and was defined as a gastrojejunostomy diameter less than that of a therapeutic endoscope (11-mm).
Stenosis occurred in 23 of 145 patients (15.9%) with a 21-mm gastrojejunostomy. Five of 81 patients with a 25-mm circular stapled anastomosis have developed a stenosis (6.2%, p = 0.03). Weight loss was similar for each sized stapler at 6 and 12 months.
The use of a 25-mm circular stapler in laparoscopic gastric bypass is preferable to a 21-mm stapler. The larger stapler is associated with a significantly decreased incidence of gastrojejunostomy stenosis without compromising early weight loss.
腹腔镜Roux-en-Y胃旁路术后胃空肠吻合口狭窄是常见情况。在已报道的系列研究中，其发生率差异很大。我们评估了圆形吻合器尺寸对狭窄发生率和体重减轻的影响。
我们最初的技术使用21毫米圆形吻合器构建胃空肠吻合口。在有大量初步经验后，我们改用25毫米吻合器。对于主诉无法进食或呕吐过多的患者，通过内镜检查确认狭窄，狭窄定义为胃空肠吻合口直径小于治疗性内镜的直径（11毫米）。
145例使用21毫米胃空肠吻合器的患者中有23例（15.9%）发生狭窄。81例使用25毫米圆形吻合器吻合的患者中有5例发生狭窄（6.2%，p = 0.03）。在6个月和12个月时，每种尺寸吻合器的体重减轻情况相似。
在腹腔镜胃旁路手术中，使用25毫米圆形吻合器优于21毫米吻合器。较大的吻合器可使胃空肠吻合口狭窄的发生率显著降低，且不影响早期体重减轻。
