在 Roux-en-Y 胃旁路手术中使用 Surgicel® Nu-knit® 加强吻合线：与牛心包条的比较。

Reinforcing the staple line with Surgicel® Nu-knit® in Roux-en-Y gastric bypass: comparison with bovine pericardial strips.

机构信息

Department of Bariatric Surgery, Orlando Regional Medical Center, Bariatric and Laparoscopy Center, Orlando Health, Orlando, FL 32806, USA.

出版信息

Obes Surg. 2013 Jun;23(6):788-93. doi: 10.1007/s11695-013-0898-y.

DOI:10.1007/s11695-013-0898-y

PMID:23471675

Abstract

BACKGROUND

In the literature, staple line leak rate is reported to be 1-6 %, and hemorrhage rate is 2-5 % in laparoscopic Roux-en-Y gastric bypass (LRYGB). Various buttress materials are available in an attempt to reduce perioperative complications. The aims of our study are to evaluate the effect of using absorbable hemostat (SNK) as buttress material and compare its usage with bovine pericardial strips (PSD).

METHODS

Between January 2006 to May 2007 and from October 2007 to December 2009, a total of 1,074 patients underwent LRYGB at our institution. Of these 1,074 patients, PSD was used in 443 (41.2 %) patients, and SNK was used in 631 (58.8 %) patients. A retrospective review of a prospectively collected database was performed for all LRYGB patients, noting the outcomes and complications of the procedure.

RESULTS

Five (1.1 %) patients required transfusion of packed red blood cells (PRBC) during early postoperative period (postoperative 1-3 days) in the PSD group, while two (0.3 %) patients required transfusion in the SNK group. SNK patients received significantly lower mean units of PRBC (1.0 unit) when compared to that of PSD patients (5.0 units). One (0.2 %) anastomotic leak was found in the PSD group on postoperative day (POD) 10. One (0.2 %) patient in the SNK group also showed an anastomotic leak on POD 2. Additionally, the cost of SNK per procedure was significantly less than that of PSD.

CONCLUSIONS

The use of absorbable hemostat as buttress material may be effective in reducing acute postoperative bleeding in LRYGB at a significantly lower cost.

摘要

背景

文献报道腹腔镜 Roux-en-Y 胃旁路术（LRYGB）的吻合口漏发生率为 1-6%，出血发生率为 2-5%。为了降低围手术期并发症，各种支持材料被应用于临床。本研究旨在评估使用可吸收止血夹（SNK）作为支撑材料的效果，并与牛心包条（PSD）进行比较。

方法

本研究回顾性分析了 2006 年 1 月至 2007 年 5 月和 2007 年 10 月至 2009 年 12 月期间在我院行 LRYGB 的 1074 例患者的临床资料。其中 443 例（41.2%）患者使用 PSD，631 例（58.8%）患者使用 SNK。记录所有 LRYGB 患者的手术结果和并发症，并进行回顾性分析。

结果

PSD 组有 5 例（1.1%）患者在术后早期（术后 1-3 天）需要输注浓缩红细胞（PRBC），而 SNK 组有 2 例（0.3%）需要输注 PRBC。SNK 组患者接受的 PRBC 平均单位数（1.0 单位）明显低于 PSD 组（5.0 单位）。PSD 组有 1 例（0.2%）患者在术后第 10 天出现吻合口漏，SNK 组有 1 例（0.2%）患者在术后第 2 天出现吻合口漏。此外，SNK 的每次手术费用明显低于 PSD。