Buckwalter J A, Herbst C A
Department of Surgery, University of North Carolina, School of Medicine, Chapel Hill 27514.
Surgery. 1988 Feb;103(2):156-60.
A leak from the stomach is the most serious complication that occurs after a gastric bariatric operation. The experience with 19 leaks that occurred after 791 gastric bariatric operations performed at North Carolina Memorial Hospital from 1975 to 1986 is described. The incidence of leaks was higher (8.3%) after a second than after a first gastric bariatric operation (2.0%). Ten leaks were life threatening and nine were not. There were no deaths. The diagnosis was made on the basis of Gastrografin swallow in seven patients, clinical findings in six, oral dye studies in three, barium study, a sinogram, and operation in one patient each. Thirteen of 16 patients were operated on within 4 hours of the diagnosis of a leak. One patient with a life-threatening leak and two with non-life-threatening leaks were managed without operations. Three patients were discharged after uncomplicated courses and readmitted, and the diagnosis of a leak was established. To minimize morbidity and mortality related to a leak, it is imperative to (1) recognize that a leak can occur after any gastric bariatric operation, (2) perform a Gastrografin swallow when a leak is suspected, and (3) operate on the patient if the Gastrografin swallow is positive or if the clinical findings suggest a leak.
胃旁路手术后发生的胃漏是最严重的并发症。本文描述了1975年至1986年在北卡罗来纳大学纪念医院进行的791例胃旁路手术后发生的19例胃漏的情况。二次胃旁路手术后胃漏的发生率（8.3%）高于首次手术（2.0%）。10例胃漏危及生命，9例未危及生命。无死亡病例。7例患者通过口服泛影葡胺造影诊断，6例根据临床表现诊断，3例通过口服染料研究诊断，1例通过钡剂造影、1例通过窦道造影、1例通过手术诊断。16例患者中有13例在诊断胃漏后4小时内接受了手术。1例危及生命的胃漏患者和2例未危及生命的胃漏患者未接受手术治疗。3例患者在病情平稳出院后再次入院，确诊为胃漏。为了将与胃漏相关的发病率和死亡率降至最低，必须做到：（1）认识到任何胃旁路手术后都可能发生胃漏；（2）怀疑有胃漏时进行口服泛影葡胺造影；（3）如果口服泛影葡胺造影呈阳性或临床表现提示胃漏，则对患者进行手术。
