胃旁路术后发生胃-胃瘘与手术技术和经验均有关系。
Gastrogastric fistula following Roux-en-Y bypass is attributed to both surgical technique and experience.
机构信息
Department of General Surgery, Case Western Reserve University School of Medicine, University Suburban Health Center, 1611 S. Green Rd., Suite 200, South Euclid, OH 44121, USA.
出版信息
Am J Surg. 2010 Mar;199(3):382-5; discussion 385-6. doi: 10.1016/j.amjsurg.2009.09.017.
BACKGROUND
The stomach can either be divided or undivided in performing Roux-en-Y gastric bypass (RGB) for morbid obesity. We evaluated whether surgical technique is the sole contributing factor to the formation of gastrogastric fistula (GGF).
METHODS
A retrospective analysis of 1,036 consecutive patients was evaluated. RGB was performed as open undivided, open divided, and laparoscopic (divided). Incidence of GGF was identified for each technique and its relationship to surgical experience was assessed.
RESULTS
Overall incidence of GGF was 1.3%. All fistulae occurred in patients who received undivided open RGB. There was a significant difference between the undivided open group and the divided open+laparoscopic groups (2.1% vs 0%, P<.01). Incidence of GGF decreased over time with increasing open undivided RGB volume.
CONCLUSIONS
GGF was only identified in undivided RGB. The occurrence decreased with increasing surgical experience. Together, overall surgical technique in addition to gastric division must play a role in fistula formation.
背景
在进行病态肥胖的 Roux-en-Y 胃旁路术（RGB）时，胃可以被分割或不分割。我们评估了手术技术是否是胃胃瘘（GGF）形成的唯一因素。
方法
对 1036 例连续患者进行回顾性分析。RGB 采用开放式不分割、开放式分割和腹腔镜（分割）进行。确定每种技术的 GGF 发生率，并评估其与手术经验的关系。
结果
GGF 的总发生率为 1.3%。所有瘘管均发生在接受不分割开放式 RGB 的患者中。不分割开放式组与分割开放式+腹腔镜组之间存在显著差异（2.1%比 0%，P<.01）。随着开放式不分割 RGB 量的增加，GGF 的发生率呈下降趋势。
结论
仅在不分割的 RGB 中发现 GGF。随着手术经验的增加，其发生率下降。总的来说，除了胃分割之外，手术技术也必须在瘘管形成中发挥作用。
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