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近端 Roux-en-Y 胃旁路术后晚期倾倒综合征患者扩张性胃肠吻合口的腔内修复(OverStitch(TM),阿波罗内镜外科公司)

Endoluminal Revision (OverStitch (TM) , Apollo Endosurgery) of the Dilated Gastroenterostomy in Patients with Late Dumping Syndrome After Proximal Roux-en-Y Gastric Bypass.

作者信息

Stier Christine, Chiappetta Sonja

机构信息

Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany.

出版信息

Obes Surg. 2016 Aug;26(8):1978-84. doi: 10.1007/s11695-016-2266-1.

Abstract

Dumping syndrome is a long-term postoperative complication of Roux-en-Y gastric bypass procedures. Morphologically, dumping syndrome usually correlates with a dilatation of the gastroenterostomy with accelerated pouch emptying. Conservative therapy includes diet changes, complementary pharmacotherapy and, if symptoms persist, surgical revision. Surgical options include endoscopic, endoluminal surgery to constrict the gastrojejunostomy using a novel endoscopic suturing device (OverStitch(TM), Apollo). In our study, we aimed to assess the viability, safety and efficacy of this procedure in patients with late dumping; 14 patients who had developed late dumping syndrome underwent surgery using an endoscopic suturing technique (OverStitch(TM), Apollo). Late dumping was confirmed by Sigstad score and an oral glucose tolerance test (OGTT). Prior to surgery, objective analysis of pouch emptying speed was assessed by gastric scintigraphy. Surgery was performed under general anaesthesia. None of the 14 patients suffered intra- or postoperative complications. No postsurgical increase in inflammation parameters was observed. The postinterventional pain scale (visual analogue scale) showed a mean score of 0.5 (range 0-10). In 13 of the 14 patients, no dumping was observed 1-month postsurgery. The postoperative Sigstad score (3.07 ± 2.06; range 1-9) showed an impressive reduction compared with the preoperative score (12.71 ± 4.18; range 7-24) (p < 0.001). Postoperative upper gastrointestinal gastrografin swallow revealed regular emptying in all the patients. The endoluminal endoscopic suturing technique-applied here for surgical revision of gastroenterostomy following Roux-en-Y gastric bypass-represents a promising, novel therapeutic option in late dumping syndrome involving minimal trauma and offering rapid reconvalescence.

摘要

倾倒综合征是Roux-en-Y胃旁路手术的一种长期术后并发症。在形态学上,倾倒综合征通常与胃肠吻合口扩张及胃袋排空加速相关。保守治疗包括饮食调整、辅助药物治疗,若症状持续,则进行手术修正。手术选择包括使用新型内镜缝合装置(OverStitch™,Apollo)进行内镜腔内手术以缩小胃空肠吻合口。在我们的研究中,我们旨在评估该手术对晚期倾倒患者的可行性、安全性和有效性;14例发生晚期倾倒综合征的患者采用内镜缝合技术(OverStitch™,Apollo)进行了手术。通过Sigstad评分和口服葡萄糖耐量试验(OGTT)确诊晚期倾倒。手术前,通过胃闪烁显像对胃袋排空速度进行客观分析。手术在全身麻醉下进行。14例患者均未出现术中或术后并发症。未观察到术后炎症参数增加。介入后疼痛量表(视觉模拟量表)显示平均评分为0.5(范围0 - 10)。14例患者中有13例在术后1个月未观察到倾倒现象。术后Sigstad评分(3.07 ± 2.06;范围1 - 9)与术前评分(12.71 ± 4.18;范围7 - 24)相比显著降低(p < 0.001)。术后上消化道泛影葡胺吞咽造影显示所有患者排空正常。本文应用的内镜腔内缝合技术用于Roux-en-Y胃旁路术后胃肠吻合口的手术修正,是晚期倾倒综合征一种有前景的新型治疗选择,具有微创和恢复快的特点。

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