袖状胃切除术与漏的风险：对 4888 例患者的系统分析。
Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients.
机构信息
Department of Surgery, University Hospitals Case Medical Center, Lakeside 7, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA.
出版信息
Surg Endosc. 2012 Jun;26(6):1509-15. doi: 10.1007/s00464-011-2085-3. Epub 2011 Dec 17.
INTRODUCTION
Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of comorbidities to that of laparoscopic gastric bypass. The simplicity of the procedure and the decreased long-term risk profile make this surgery more appealing. Nonetheless, the ever present risk of a staple-line leak is still of great concern and needs further investigation.
METHODS
An electronic literature search of MEDLINE database plus manual reference checks of articles published on laparoscopic sleeve gastrectomy for morbid obesity and its complications was completed. Keywords used in the search were "sleeve gastrectomy" OR "gastric sleeve" AND "leak." We analyzed 29 publications, including 4,888 patients. We analyzed the frequency of leak after sleeve gastrectomy and its associated risks of causation.
RESULTS
The risk of leak after sleeve gastrectomy in all comers was 2.4%. This risk was 2.9% in the super-obese [body mass index (BMI) > 50 kg/m(2)] and 2.2% for BMI < 50 kg/m(2). Staple height and use of buttressing material did not affect leak rate. The use of a size 40-Fr or greater bougie was associated with a leak rate of 0.6% compared with those who used smaller sizes whose leak rate was 2.8%. Leaks were found at the proximal third of the stomach in 89% of cases. Most leaks were diagnosed after discharge. Endoscopic management is a viable option for leaks and was documented in 11% of cases as successful.
CONCLUSIONS
Sleeve gastrectomy has become an important surgical option for the treatment of the ever growing morbidly obese population. The risk of leak is low at 2.4%. Attention to detail specifically at the esophagogastric junction cannot be stressed enough. Careful patient selection (BMI < 50 kg/m(2)) and adopting the use of a 40-Fr or larger bougie may decrease the risk of leak. Vigilant follow-up during the first 30 days is critical to avoid catastrophe, because most leaks will happen after patient discharge.
简介
袖状胃切除术已成为一种流行的独立减重手术，其减重效果和并发症的解决与腹腔镜胃旁路术相当。该手术操作简单，长期风险较低，因此更具吸引力。尽管如此，吻合口漏的风险仍然是一个很大的关注点，需要进一步研究。
方法
我们对 MEDLINE 数据库进行了电子文献检索，并对发表的关于腹腔镜袖状胃切除术治疗病态肥胖及其并发症的文章进行了手动参考文献检查。检索中使用的关键词是“sleeve gastrectomy”或“gastric sleeve”以及“leak”。我们分析了 29 篇文献，共包括 4888 例患者。我们分析了袖状胃切除术后吻合口漏的发生率及其相关的致病风险。
结果
所有患者的袖状胃切除术后吻合口漏的风险为 2.4%。超级肥胖患者（BMI>50 kg/m²）的风险为 2.9%，BMI<50 kg/m²的风险为 2.2%。吻合口高度和使用支撑材料并不影响漏口率。使用 40-Fr 或更大的扩张器与使用较小尺寸扩张器（漏口率为 2.8%）相比，漏口率为 0.6%。89%的漏口发生在胃的近端三分之一。大多数漏口在出院后被诊断出来。内镜治疗是一种可行的治疗方法，在 11%的病例中被证明是成功的。
结论
袖状胃切除术已成为治疗日益增长的病态肥胖人群的重要手术选择。吻合口漏的风险很低，为 2.4%。特别要注意食管胃结合部的细节。仔细选择患者（BMI<50 kg/m²）并采用 40-Fr 或更大的扩张器可能会降低漏口的风险。在最初的 30 天内进行严密的随访至关重要，以避免发生灾难性后果，因为大多数漏口会发生在患者出院后。
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