Department of Diagnostic Radiology, University Hospital Freiburg, Albert-Ludwigs-University, Hugstetter Straße 55, 79106, Freiburg, Germany.
Surg Endosc. 2011 Jul;25(7):2323-9. doi: 10.1007/s00464-010-1558-0. Epub 2011 Feb 7.
Laparoscopic sleeve gastrectomy (LSG) is frequently performed as a definitive bariatric procedure today. Quantitative data on the detailed anatomy of the stomach after LSG are yet sparse.
Thirty-two multislice computed tomography (MSCT) data sets acquired in 27 LSG patients (22 female, 5 male) with a dedicated examination protocol and post-processing were evaluated for gastric volume, stomach length, sleeve length, antrum length, staple line length, and maximum cross-sectional sleeve area. Obtained parameters were compared to time after surgery, weight loss, and the occurrence of postsurgical regurgitation.
Mean gastric volume was 186.5±88.4 ml. Gastric volume correlated significantly with the time interval after surgery. Sleeve sizes of 105.3±30.2 ml during early follow-up confirmed correct primary sizing of the sleeve, whereas marked dilation to 196.8±84.3 ml was found in patients with a follow-up of 6 months and longer (p=0.038). Sleeve area and staple line length were also positively correlated with time after surgery. No correlation was found between gastric volume and excess weight loss. In ten patients an intrathoracic migration of the staple line could be noted, with four of these patients developing persistent regurgitation after LSG. Regurgitation was present in only 2 of 17 patients without sleeve herniation.
Multislice computed tomography allows for a comprehensive and quantitative evaluation of the anatomy after LSG and thus provides new insights in the process of sleeve dilation. Intrathoracic migration of the staple line could be identified as a possible cause of persistent regurgitation.
腹腔镜袖状胃切除术（LSG）如今常被作为一种确定性减重手术。LSG 后胃详细解剖的定量数据仍然很少。
对 27 例 LSG 患者（22 例女性，5 例男性）的 32 例多层螺旋 CT（MSCT）数据集进行评估，这些患者采用了专门的检查方案和后处理，评估内容包括胃容量、胃长度、袖状长度、胃窦长度、吻合线长度和最大横截面积。获得的参数与术后时间、体重减轻和术后反流的发生进行比较。
平均胃容量为 186.5±88.4ml。胃容量与术后时间间隔呈显著相关。在早期随访中，袖状大小为 105.3±30.2ml 证实了袖套的正确初步尺寸，而在随访 6 个月及以上的患者中，发现明显扩张至 196.8±84.3ml（p=0.038）。袖套面积和吻合线长度也与术后时间呈正相关。胃容量与超重减轻之间无相关性。在 10 例患者中，可注意到吻合线的胸腔内迁移，其中 4 例患者在 LSG 后出现持续性反流。在没有袖套疝的 17 例患者中，仅 2 例存在反流。
多层螺旋 CT 可对 LSG 后的解剖结构进行全面和定量评估，从而为袖套扩张过程提供新的见解。吻合线的胸腔内迁移可被认为是持续性反流的一个可能原因。
