Rasmussen J J, Fuller W, Ali M R
Department of Surgery, University of California, Davis, 2221 Stockton Boulevard, Sacramento, CA 95817, USA.
Surg Endosc. 2007 Jul;21(7):1090-4. doi: 10.1007/s00464-007-9285-x. Epub 2007 May 19.
Marginal ulceration after Roux-en-Y gastric bypass (RYGB) is diagnosed in 1% to 16% of patients. The factors predisposing patients to marginal ulceration are still unclear.
A total of 260 patients who underwent laparoscopic RYGB were retrospectively reviewed. Data regarding demographics, comorbidities, body mass index (BMI), Helicobacter pylori infection, gastrojejunal (GJ) anastomotic leaks, postoperative bleeding, operative time, type of suture material, and marginal ulcer formation were collected. Fisher's exact test was used for statistical analysis of discrete variables, and Student's t-test was used for continuous variables. Statistical significance was set at an alpha of 0.05.
The overall marginal ulceration rate was 7%. Demographic data (age, gender distribution, BMI) did not differ significantly between patients who experienced marginal ulceration and those who did not (p > 0.05). Similarly, technical factors (choice of permanent or absorbable suture for the GJ anastomosis, attending as primary surgeon, robotic GJ, operative time, postoperative hematocrit drop) were not statistically different between the two groups (p > 0.05). Finally, the prevalence of comorbidities (diabetes, hypertension, obstructive sleep apnea, musculoskeletal complaints, dyslipidemia, gastroesophageal reflux disease [GERD] and peptic ulcer disease [PUD]) did not differ significantly between the two groups (p > 0.05). However, preoperative H. pylori infection, although adequately treated, was twice as common among the patients who had marginal ulceration (32%) as among those who did not (12%) (p = 0.02). All the patients who experienced marginal ulcers had complete resolution of symptoms with proton pump inhibitors and sucralfate. No reoperations were required for marginal ulceration.
Helicobacter pylori may potentiate marginal ulcer formation. The authors hypothesize that H. pylori damages the mucosal barrier in a way that persists postoperatively, which may precipitate marginal ulceration even when the organism has been medically eradicated.
Roux-en-Y胃旁路术（RYGB）后边缘性溃疡在1%至16%的患者中被诊断出来。导致患者发生边缘性溃疡的因素仍不清楚。
对260例行腹腔镜RYGB的患者进行回顾性分析。收集有关人口统计学、合并症、体重指数（BMI）、幽门螺杆菌感染、胃肠吻合口漏、术后出血、手术时间、缝合材料类型和边缘性溃疡形成的数据。采用Fisher精确检验对离散变量进行统计分析，采用Student t检验对连续变量进行统计分析。统计学显著性设定为α=0.05。
总体边缘性溃疡发生率为7%。发生边缘性溃疡的患者与未发生边缘性溃疡的患者在人口统计学数据（年龄、性别分布、BMI）方面无显著差异（p>0.05）。同样，技术因素（胃肠吻合口选择永久性或可吸收缝线、术者为主治医生、机器人辅助胃肠吻合、手术时间、术后血细胞比容下降）在两组之间无统计学差异（p>0.05）。最后，两组患者合并症（糖尿病、高血压、阻塞性睡眠呼吸暂停、肌肉骨骼疾病、血脂异常、胃食管反流病[GERD]和消化性溃疡病[PUD]）的患病率无显著差异（p>0.05）。然而，术前幽门螺杆菌感染，尽管已得到充分治疗，但在发生边缘性溃疡的患者中（32%）是未发生边缘性溃疡患者中（12%）的两倍（p=0.02）。所有发生边缘性溃疡的患者使用质子泵抑制剂和硫糖铝后症状均完全缓解。边缘性溃疡无需再次手术。
幽门螺杆菌可能会促进边缘性溃疡的形成。作者推测，幽门螺杆菌以一种术后仍持续存在的方式损害黏膜屏障，即使该病原体已通过药物根除，也可能促使边缘性溃疡形成。
