初次减重手术后术中漏诊测试对术后与漏诊相关结局的影响：MBSAQIP 数据库分析。
Effects of intraoperative leak testing on postoperative leak-related outcomes after primary bariatric surgery: an analysis of the MBSAQIP database.
机构信息
Department of Surgery, Division of Gastrointestinal/Minimally Invasive Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
出版信息
Surg Obes Relat Dis. 2019 Sep;15(9):1530-1540. doi: 10.1016/j.soard.2019.06.008. Epub 2019 Jun 17.
BACKGROUND
Intraoperative leak test (IOLT) is commonly performed to evaluate the integrity of an anastomosis or staple line during bariatric surgery. However, the utility of IOLT is controversial.
OBJECTIVE
To evaluate the effect of IOLT on postoperative leak-related outcomes after primary bariatric surgery.
SETTING
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited centers.
METHODS
The 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement databases were analyzed for sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (BPDDS) to determine the postoperative anastomotic/staple line leak (A/SL) and leak-related outcomes.
RESULTS
Data for a total of 265,309 patients who underwent SG (69.6%), RYGB (29.7%), or BPDDS (.8%) were analyzed. IOLT was performed in 81.9% of all patients. Overall A/SL, mortality rate in patients with leakage, and 30-day leak-related mortality were .28%, .1%, and .003%, respectively. There were no significant differences between the IOLT and non-IOLT groups in terms of A/SL, 30-day mortality in patients with leakage, 30-day leak-related mortality, readmission, reoperation, intervention, or organ/space surgical site infection. However, the rate of 30-day leak-related intervention in BPDDS was significantly lower in the IOLT group compared to the non-IOLT group (.18% versus 1.15%, P = .01). Whether IOLT was performed endoscopically or nonendoscopically had no effect on the rate of postoperative leaks. Overall mean operative time increased by 19.1 minutes (9.5, 11.9, and 21.2 min for SG, RYGB, and BPDDS, respectively) when IOLT was performed.
CONCLUSION
The overall rate of postoperative A/SL and leak-related morbidity was low. This study provided no evidence of either benefit or harm from IOLT in patients who underwent SG, RYGB, or BPDDS.
背景
术中漏检（IOLT）常用于评估减重手术后吻合口或钉线的完整性。然而，IOLT 的效用存在争议。
目的
评估原发性减重手术后 IOLT 对术后漏相关结局的影响。
设置
代谢和减重手术认证和质量改进计划认证中心。
方法
分析 2015 年和 2016 年代谢和减重手术认证和质量改进数据库，以确定袖状胃切除术（SG）、Roux-en-Y 胃旁路术（RYGB）和胆胰分流十二指肠转位术（BPDDS）的术后吻合口/钉线漏（A/SL）和漏相关结局。
结果
共分析了 265309 例接受 SG（69.6%）、RYGB（29.7%）或 BPDDS（0.8%）的患者的数据。所有患者中有 81.9%进行了 IOLT。总体 A/SL、漏患者的死亡率和 30 天漏相关死亡率分别为 0.28%、0.1%和 0.003%。IOLT 组和非 IOLT 组在 A/SL、漏患者的 30 天死亡率、30 天漏相关死亡率、再入院、再次手术、干预或器官/空间手术部位感染方面无显著差异。然而，与非 IOLT 组相比，BPDDS 组 30 天漏相关干预的发生率在 IOLT 组显著降低（0.18%比 1.15%，P = 0.01）。无论 IOLT 是内镜下进行还是非内镜下进行，对术后漏的发生率均无影响。总体而言，当进行 IOLT 时，手术时间平均增加 19.1 分钟（SG、RYGB 和 BPDDS 分别为 9.5、11.9 和 21.2 分钟）。
结论
术后 A/SL 和漏相关发病率总体较低。本研究未提供证据表明 SG、RYGB 或 BPDDS 患者行 IOLT 有益或有害。
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