Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Surg Obes Relat Dis. 2019 Jul;15(7):1075-1079. doi: 10.1016/j.soard.2019.04.033. Epub 2019 May 13.
Leak at the gastrojejunostomy (GJ) after Roux-en-Y gastric bypass is a rare but life-threatening complication.
To assess incidence, risk factors, treatment, and outcome of leaks at the GJ after Roux-en-Y gastric bypass in a nationwide cohort.
Sweden.
Leaks at GJ within 30 days postoperatively in 40,844 patients (age 41 yr, females 76%, and body mass index of 42.4 kg/m) between 2007 and 2014 in the Scandinavian Obesity Surgery Registry were assessed. Register data and outcomes were verified by reviewing patient charts. Logistic regression was done to estimate odds ratios (ORs) for significant risk factors.
Leak at the GJ was registered in 262 (.6%) patients, with 44% diagnosed within the first 3 postoperative days. Risk factors were male sex (OR 1.5 [1.1-1.9]), age ≥49 years (OR 1.9 [1.3-2.7]), diabetes (OR 1.4 [1.1-1.9]), conversion to open surgery (OR 3.9 [2.2-6.9]), and operative time ≥90 minutes (OR 2.6 [1.8-3.8]). In most patients, the leak resulted in a severe complication. Reoperative surgery was done in 85%, with the placement of a feeding gastrostomy in 24%. Stents were used at some time point in 31% of leaks. Of all patients with leaks, 25% required intensive care, 4% developed multiorgan failure, and 1% died. Median duration of stay for patients with leaks was 22 days, versus 2 days for others (P < .001).
GJ leaks occurred in .6% of patients. Risk factors were male sex, age ≥49 years, diabetes, operative time ≥90 minutes, and conversion to open surgery. Surgical reintervention was common. Mortality was 1%.
Roux-en-Y 胃旁路术后胃空肠吻合口漏是一种罕见但危及生命的并发症。
在全国范围内评估 Roux-en-Y 胃旁路术后胃空肠吻合口漏的发生率、危险因素、治疗和结局。
瑞典。
在 2007 年至 2014 年期间，在斯堪的纳维亚肥胖手术登记处登记了 40844 例（年龄 41 岁，女性占 76%，体重指数为 42.4kg/m）术后 30 天内发生的胃空肠吻合口漏的患者，评估了吻合口漏的发生率。通过查阅患者病历，对登记数据和结局进行了验证。采用 logistic 回归估计显著危险因素的比值比（OR）。
胃空肠吻合口漏在 262 例（6%）患者中发生，44%在术后 3 天内诊断。危险因素包括男性（OR 1.5 [1.1-1.9]）、年龄≥49 岁（OR 1.9 [1.3-2.7]）、糖尿病（OR 1.4 [1.1-1.9]）、转为开腹手术（OR 3.9 [2.2-6.9]）和手术时间≥90 分钟（OR 2.6 [1.8-3.8]）。大多数患者的漏口导致严重并发症。85%的患者接受了再次手术，其中 24%放置了胃造口管。31%的患者在某个时间点使用了支架。所有漏口患者中有 25%需要重症监护，4%发生多器官功能衰竭，1%死亡。漏口患者的中位住院时间为 22 天，而其他患者为 2 天（P<0.001）。
胃空肠吻合口漏在患者中的发生率为 6%。危险因素包括男性、年龄≥49 岁、糖尿病、手术时间≥90 分钟和转为开腹手术。再次手术是常见的。死亡率为 1%。
