Fukumoto Royd, Orlina Jeraldine, McGinty James, Teixeira Julio
Department of Surgery, St.Luke's Roosevelt Hospital, New York, New York, USA.
Surg Obes Relat Dis. 2007 Jan-Feb;3(1):68-71; discussion 71-2. doi: 10.1016/j.soard.2006.10.011. Epub 2006 Dec 27.
This study examined the feasibility of using Polyflex stents in the treatment of enteric leaks after various bariatric operations. Chronic and acute leaks were treated.
We performed a retrospective case series review. Four patients received 6 Polyflex stents to treat complications of bariatric surgery. Two presented with early sepsis before stenting. One presented with abdominal pain. One presented with a chronic persistent fistula with an associated abscess. Stenting was performed under endoscopy with fluoroscopic guidance. The stents were left in place for 6 weeks.
All patients tolerated a clear liquid diet within 24 hours of stenting and were able to be advanced to a pureed diet. All patients improved clinically after stenting. Three patients with acute leaks sealed their leaks after stent placement. One patient with a chronic leak persisted and required operative closure after a second stent was placed and failed. All patients experienced short-term nausea, as well as early satiety that lasted the duration of the stenting. One patient experienced hypersialisis while the stent was in place. Two stents migrated, although this had no effect on leak closure. One patient had an anastomotic stenosis successfully treated with a second stent.
Polyflex stents are useful in bypassing acute upper intestinal leaks after various bariatric operations. They provide a temporary bridge for wound healing with continued oral intake. Stenting provides a minimally invasive option in the management of acute leaks and, in our experience, had no serious associated morbidity.
本研究探讨了使用Polyflex支架治疗各种减肥手术后肠漏的可行性。对慢性和急性漏进行了治疗。
我们进行了一项回顾性病例系列研究。4例患者接受了6个Polyflex支架以治疗减肥手术并发症。2例在置入支架前出现早期脓毒症。1例出现腹痛。1例出现慢性持续性瘘并伴有脓肿。在内镜检查及透视引导下置入支架。支架留置6周。
所有患者在置入支架后24小时内耐受清流食，并能够逐渐过渡到泥状食物。所有患者在置入支架后临床症状均有改善。3例急性漏患者在置入支架后漏口闭合。1例慢性漏患者在置入第二个支架失败后仍持续漏液，需要手术闭合。所有患者均经历了短期恶心以及在支架留置期间持续存在的早饱感。1例患者在支架留置期间出现唾液分泌过多。2个支架发生移位，不过这对漏口闭合没有影响。1例患者的吻合口狭窄通过置入第二个支架成功治疗。
Polyflex支架有助于绕过各种减肥手术后的急性上消化道漏。它们为伤口愈合提供了一个临时桥梁，同时可继续经口进食。置入支架为急性漏的处理提供了一种微创选择，根据我们的经验，没有严重的相关并发症。
