Sapala J A, Wood M H, Sapala M A, Flake T M
Surgical Services, Detroit Riverview Hospital, MI, USA.
Obes Surg. 1998 Oct;8(5):505-16. doi: 10.1381/096089298765554061.
Marginal ulceration (MU) after Roux-en-Y gastric bypass (RYGB) is a well-recognized complication. Its incidence varies between 1% and 16%. Factors associated with the development of MU include pouch size, pouch orientation, staple line integrity, and mucosal ischemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori may also contribute to MU, but their mechanism of action in the RYGB patient has not been studied.
In 1994 a prospective 3-year study was designed to document the incidence of MU after near-total gastric bypass (NTGB). In this procedure the transected pouch was limited to the cardia, and the gastrojejunostomy was made along the greater curvature. A total of 173 patients entered the study. All patients who experienced postoperative nausea, vomiting, or abdominal pain underwent endoscopic examination of the pouch, stoma, and proximal Roux-en-Y limb. Gastrograffin studies were used within the first 2 weeks of operation.
One year after operation, MU was not identified in any patient. At 3 years follow-up, MU was documented in one patient (0.6%) with a dilated gastric reservoir (60 cc).
This study reviews the etiology, diagnosis, and treatment of MU in the RYGB patient and offers specific recommendations to reduce its occurrence. It also confirms a preliminary impression that NTGB is an effective operation in preventing MU formation.
Roux-en-Y胃旁路术（RYGB）后边缘溃疡（MU）是一种公认的并发症。其发生率在1%至16%之间。与MU发生相关的因素包括胃囊大小、胃囊方向、吻合钉线完整性和黏膜缺血。非甾体抗炎药（NSAIDs）和幽门螺杆菌也可能导致MU，但它们在RYGB患者中的作用机制尚未得到研究。
1994年设计了一项为期3年的前瞻性研究，以记录近全胃旁路术（NTGB）后MU的发生率。在此手术中，横断的胃囊仅限于贲门，胃空肠吻合术沿大弯进行。共有173名患者进入该研究。所有出现术后恶心、呕吐或腹痛的患者均接受了胃囊、吻合口和近端Roux-en-Y肠袢的内镜检查。在术后2周内进行了泛影葡胺检查。
术后1年，未在任何患者中发现MU。在3年随访时，在1例胃储袋扩张（60 cc）的患者中记录到MU（0.6%）。
本研究回顾了RYGB患者MU的病因、诊断和治疗，并提供了减少其发生的具体建议。它还证实了一个初步印象，即NTGB是预防MU形成的有效手术。
