Kriwanek Stephan, Ott Nada, Ali-Abdullah Sirwan, Pulgram Thomas, Tscherney Robert, Reiter Markus, Roka Rudolf
Department of Surgery, Rudolfstiftung Hospital, Vienna, Austria.
Obes Surg. 2006 Dec;16(12):1669-74. doi: 10.1381/096089206779319365.
Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gastric bypass (RYGBP) surgery. Most authors agree that operative treatment is the mainstay of therapy in patients with signs of sepsis. However, intestinal contents causing localized infection may impede healing of sutured leaks in some patients, and fistulas develop. Because the anastomosis cannot be disconnected or exteriorized for anatomical reasons, other forms of treatment have to be applied. The following case-reports describe a technique with implantation of coated self-expanding stents. Leakage of the gastro-jejunostomy occurred in one patient 3 days after RYGBP and resulted in formation of a fistula. A fistula developed in a second patient 63 days after RYGBP. Coated self-extending stents were implanted endoscopically in both patients on postoperative days 19 and 67. Enteral nutrition could be started 6 days later. Stents were removed 2 months after implantation without problems. Weight loss and quality of life 7 and 21 months after stent removal have been excellent in both patients. Implantation of coated self-expanding stents was an effective and minimally invasive option for gastro-jejunal anastomotic fistulas after RYGBP where surgical repair was not possible. In these cases, application of stents allows septic source control without any other intervention.
胃空肠吻合口漏和形成瘘是Roux-en-Y胃旁路术（RYGBP）的主要缺点。大多数作者认为，对于有脓毒症迹象的患者，手术治疗是主要的治疗方法。然而，在一些患者中，引起局部感染的肠内容物可能会妨碍缝合口漏的愈合，进而形成瘘。由于解剖学原因，吻合口无法断开或外置，因此必须采用其他治疗方式。以下病例报告描述了一种植入覆膜自膨式支架的技术。一名患者在RYGBP术后3天发生胃空肠吻合口漏，并导致瘘的形成。另一名患者在RYGBP术后63天出现瘘。两名患者分别在术后第19天和第67天通过内镜植入了覆膜自膨式支架。6天后可开始肠内营养。支架在植入2个月后顺利取出。两名患者在取出支架7个月和21个月后的体重减轻情况及生活质量均良好。对于无法进行手术修复的RYGBP术后胃空肠吻合口瘘，植入覆膜自膨式支架是一种有效且微创的选择。在这些病例中，应用支架无需任何其他干预即可控制感染源。
