Stephenson Derek, Moon Rena C, Teixeira Andre F, Jawad Muhammad A
Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
Surg Obes Relat Dis. 2014 Jul-Aug;10(4):666-70. doi: 10.1016/j.soard.2014.01.026. Epub 2014 Jan 30.
Jejuno-jejunal (J-J) intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB). Prompt diagnosis is critical as it may lead to obstruction and bowel necrosis, but clinical presentation is nonspecific. A definitive treatment plan has not been established with intussusception after RYGB. The aim of our study was to describe clinical presentation and outcomes of treatment in patients with intussusception after RYGB.
Out of 3022 patients who underwent laparoscopic RYGB between January 2003 and January 2013, 12 (0.4%) patients presented with intussusception after RYGB. A retrospective review of a prospectively collected database was performed.
Of the 12 patients, 11 (91.7%) presented with left or right upper quadrant abdominal pain as their chief complaint, and 1 (8.3%) presented with persistent nausea and vomiting. Diagnosis was made by computed tomographic scan (n = 1) or intraoperative findings (n = 11) at a mean period of 24.9 ± 26.0 months (range 3-85) after laparoscopic RYGB. Seven (58.3%) patients were treated only with reduction, 2 (16.7%) with resection and revision of J-J anastomosis, the remaining 3 (25.0%) underwent imbrication/plication of the J-J anastomosis. Only 1 (8.3%) patient, who was treated by reduction, returned with subsequent finding of recurrent intussusception at 9 months. All patients did well at a mean follow-up of 12.7 ± 16.4 months (range 1-47).
While reduction alone of the intussusception is safe and effective, there is a risk of recurrence, and imbrication of the J-J anastomosis may be a more effective means of treatment.
空肠-空肠套叠是Roux-en-Y胃旁路术（RYGB）后一种罕见的并发症。由于其可能导致肠梗阻和肠坏死，及时诊断至关重要，但临床表现缺乏特异性。目前尚未确立RYGB术后套叠的明确治疗方案。我们研究的目的是描述RYGB术后套叠患者的临床表现及治疗结果。
在2003年1月至2013年1月期间接受腹腔镜RYGB手术的3022例患者中，有12例（0.4%）术后出现套叠。对前瞻性收集的数据库进行回顾性分析。
12例患者中，11例（91.7%）以左上腹或右上腹疼痛为主诉，1例（8.3%）以持续性恶心呕吐为主诉。诊断通过计算机断层扫描（n = 1）或术中发现（n = 11）做出，时间为腹腔镜RYGB术后平均24.9±26.0个月（范围3 - 85个月）。7例（58.3%）患者仅接受复位治疗，2例（16.7%）接受切除并修复空肠-空肠吻合术，其余3例（25.0%）进行空肠-空肠吻合术的折叠/襞形成术。仅1例接受复位治疗的患者在9个月时出现复发性套叠。所有患者在平均12.7±16.4个月（范围1 - 47个月）的随访中情况良好。
虽然单纯套叠复位安全有效，但存在复发风险，空肠-空肠吻合术的折叠术可能是更有效的治疗方法。
