Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 rd., Bangkok, 10330, Thailand.
Surg Endosc. 2019 Feb;33(2):520-527. doi: 10.1007/s00464-018-6326-6. Epub 2018 Jul 12.
Early postoperative jejunal limb obstruction is a rare complication following gastric surgery with jejunal reconstruction. The condition is mainly attributed to kinking of the jejunal limbs, gastrojejunal or jejunojejunal anastomosis. There has been currently limited information regarding the safety and efficacy of endoscopic treatment in patients with early postoperative jejunal obstruction. We aimed to investigate outcome of endoscopic small-bore naso-jejunal (N-J) tube stenting across the obstructed segment in patients with uncomplicated early postoperative partial jejunal limb obstruction.
All patients diagnosed of jejunal limb obstruction within 8 weeks after gastric-related surgery were reviewed. Patients with malignant obstruction, complete closed loop obstruction, sepsis, instability, intestinal strangulation, or perforation were excluded. All patients underwent endoscopic dekinking and stenting for 2 weeks with an N-J tube using 16-French single lumen plastic nasogastric tube across the obstruction segment after failed conservative therapy. Successful N-J tube placement across the obstruction point was confirmed by contrast study. Complications, technical, and clinical success were evaluated.
Twenty-one patients met the criteria. The primary operations were 7 partial gastrectomies with Billroth-II reconstruction, 7 total or partial gastrectomies with Roux-en-Y reconstruction and 4 Whipple's operations, 2 bypass procedures, and 1 proximal gastrectomy. Most common site of obstruction was jejunojejunal anastomosis and gastrojejunal anastomosis following Roux-en-Y and Billroth-II reconstruction, respectively. Endoscopic N-J tube placement was technically successful in 20 out of 21 patients (95%). One patient had aspirated pneumonia. There was no procedure-related mortality. After N-J tube removal, clinical success was demonstrated in 19 out of 20 patients (95%) at the median duration of 6 months. One patient underwent reoperation due to repeated tube dislodgement.
Endoscopic stenting with a 16-F naso-jejunal tube across the angulated segment is safe and effective for treatment of patients with uncomplicated early postoperative partial jejunal limb obstruction following gastric surgery with jejunal reconstruction.
胃手术后重建空肠后，早期术后空肠支梗阻是一种罕见的并发症。这种情况主要归因于空肠支的扭结、胃空肠或空肠空肠吻合口。目前关于内镜治疗早期术后空肠梗阻患者的安全性和疗效的信息有限。我们旨在研究内镜小口径鼻空肠（N-J）管穿过梗阻段治疗胃相关手术后 8 周内诊断为空肠支梗阻且无并发症的患者的结果。
回顾所有诊断为空肠支梗阻的患者，这些患者均在胃相关手术后 8 周内接受检查。排除恶性梗阻、完全闭襻性梗阻、脓毒症、不稳定、肠绞窄或穿孔的患者。所有患者均在保守治疗失败后，使用 16 号单腔塑料鼻胃管经内镜行 dekinking 并在梗阻段放置 N-J 管 2 周。通过对比研究确认 N-J 管成功穿过梗阻点。评估并发症、技术和临床成功率。
21 名患者符合标准。主要手术方式为 7 例胃部分切除术伴 Billroth-II 重建、7 例全胃或胃部分切除术伴 Roux-en-Y 重建和 4 例 Whipple 手术、2 例旁路手术和 1 例近端胃切除术。梗阻最常见的部位是 Roux-en-Y 和 Billroth-II 重建后的空肠空肠吻合口和胃空肠吻合口。21 例患者中有 20 例（95%）内镜 N-J 管放置技术成功。1 例患者发生吸入性肺炎。无与操作相关的死亡率。N-J 管取出后，20 例中有 19 例（95%）患者在中位 6 个月时表现出临床成功。1 例患者因反复管脱落而再次手术。
对于胃手术后重建空肠后出现早期术后部分空肠支梗阻且无并发症的患者，内镜下用 16 号鼻空肠管穿过成角段进行支架置入是安全有效的。
