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[腹腔镜Roux-en-Y胃旁路术后空肠空肠吻合口扭结所致小肠梗阻的机制与临床处理]

[Mechanisms and clinical management of small bowel obstruction caused by kinking of the jejunojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass].

作者信息

Shi Y, Cao K, Wang Z J, Han J G

机构信息

Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2024 May 1;62(5):457-461. doi: 10.3760/cma.j.cn112139-20231130-00247.

Abstract

Currently, obesity and its complications have become increasingly serious health issues. Bariatric surgery is an effective method of treating obesity and related metabolic complications. Among them, Roux-en-Y gastric bypass (RYGB) is still considered the "gold standard" procedure for bariatric surgery. Small bowel obstruction is one of the possible complications after RYGB, and in addition to the formation of intra-abdominal hernias, kinking of the jejunojejunal anastomosis is an important cause of small bowel obstruction. The early clinical symptoms of kinking of the jejunojejunal anastomosis often lack clarity in the early stages. Therefore, early diagnosis, prevention, and effective treatment of kinking of the jejunojejunal anastomosis are challenging but crucial. The occurrence of kinking of the jejunojejunal anastomosis may be related to surgical techniques and the surgeon's experience. The use of anti-obstruction stitch, mesenteric division, and bidirectional jejunojejunal anastomosis may be beneficial in preventing kinking of the jejunojejunal anastomosis. If kinking of the jejunojejunal anastomosis occurs, timely abdominal CT scans and endoscopic examinations should be performed. Gastric and intestinal decompression should be initiated immediately, and exploratory surgery should be prepared.

摘要

目前,肥胖及其并发症已成为日益严重的健康问题。减重手术是治疗肥胖及相关代谢并发症的有效方法。其中,Roux-en-Y胃旁路术(RYGB)仍是减重手术的“金标准”术式。小肠梗阻是RYGB术后可能出现的并发症之一,除腹腔内疝形成外,空肠空肠吻合口扭结是小肠梗阻的重要原因。空肠空肠吻合口扭结的早期临床症状在早期往往不明确。因此,空肠空肠吻合口扭结的早期诊断、预防和有效治疗具有挑战性但至关重要。空肠空肠吻合口扭结的发生可能与手术技术及术者经验有关。使用防梗阻缝线、肠系膜离断和双向空肠空肠吻合可能有助于预防空肠空肠吻合口扭结。如果发生空肠空肠吻合口扭结,应及时进行腹部CT扫描和内镜检查。应立即进行胃肠减压,并做好剖腹探查手术准备。

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