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全身应用类固醇治疗腹腔镜远端胃切除术中三角形吻合术后水肿性吻合口狭窄:一例报告

Systemic steroid application for treatment of edematous anastomotic stenosis following delta-shaped anastomosis in laparoscopic distal gastrectomy: a case report.

作者信息

Arima Jun, Taniguchi Kohei, Kobayashi Toshihiro, Tsunematsu Ichiro, Kagota Shuji, Sakane Junna, Suzuki Yusuke, Uchiyama Kazuhisa, Hiramatsu Masako

机构信息

Takatsuki Red Cross Hospital, 1-1-1 Abuno, Takatsuki, Osaka, 569-1096, Japan.

Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.

出版信息

BMC Surg. 2020 Jul 22;20(1):163. doi: 10.1186/s12893-020-00827-3.

Abstract

BACKGROUND

Delta-shaped anastomosis is a common method of intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy. One common postoperative complication of this procedure is anastomotic stenosis, and endoscopic balloon dilatation is a major remedy for such complications. Other treatment strategies are necessary to manage unsuccessful endoscopic balloon dilatation.

CASE PRESENTATION

We present a case where systemic steroid treatment was applied in sustained anastomotic stenosis after endoscopic balloon dilatation. We performed delta-shaped anastomosis in laparoscopic distal gastrectomy to treat early-stage gastric cancer in a patient. The patient experienced abdominal pain post-surgery; subsequent investigation revealed edematous anastomotic stenosis. The stenosis sustained even after endoscopic balloon dilatation and local steroid injection. Consequently, we applied systemic steroid treatment.

CONCLUSION

Systemic steroid treatment improved the stenosis and no recurrence was observed. These results suggest that systemic steroid application could be useful to treat anastomotic stenosis.

摘要

背景

三角形吻合术是全腹腔镜远端胃切除术中常见的体内胃十二指肠吻合方法。该手术常见的术后并发症之一是吻合口狭窄,内镜下球囊扩张是治疗此类并发症的主要方法。对于内镜下球囊扩张治疗失败的情况,需要其他治疗策略。

病例报告

我们报告一例在内镜下球囊扩张后持续性吻合口狭窄应用全身类固醇治疗的病例。我们对一名患者进行腹腔镜远端胃切除术并采用三角形吻合术治疗早期胃癌。患者术后出现腹痛;随后的检查发现吻合口水肿性狭窄。即使在内镜下球囊扩张和局部类固醇注射后,狭窄仍持续存在。因此,我们应用了全身类固醇治疗。

结论

全身类固醇治疗改善了狭窄,且未观察到复发。这些结果表明全身应用类固醇可能有助于治疗吻合口狭窄。

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