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背景袖状胃切除术由于手术操作简单、效果确切,在减肥手术中应用越来越多。但该手术后残胃漏是一个需要大家关注和研究的问题。方法用袖状胃切除术和漏作为关键词,在Medline检索。对检索出的文章,再用人工筛选,最后找出29篇文章,涉及4888例手术。文章重点集中在残胃漏发生率和影响漏产生的因素。结果在4888例袖状胃切除术中,术后残胃漏的发生率是2.4%。超级肥胖(BMI>50)残胃漏发生率为3.0%(23/771);而BMI<50病人术后残胃漏发生率为2.2%(92/4117)。吻合器钉匣的高度和一些切缘加强方法并不能减少袖状胃切除术后残胃漏的发生。用40Fr或以上型号的扩张器,袖状胃切除术后残胃漏发生率为0.6%;而小型号扩张器术后残胃漏发生率为2.8%。89%残胃漏发生在胃的近端,大部分残胃漏发生在手术第10天以后。残胃漏发生后,可在内镜下放置支撑架或腹腔镜下放置腹腔引流管进行治疗。结论袖状胃切除术后,残胃漏发生率为2.4%。在胃切除时,不要过于靠近食管胃结合处。一旦残胃漏发生,可采用微创方法处理。
Background Sleeve gastrectomy due to the simple operation, the exact effect, more and more applications in bariatric surgery. However, the postoperative gastric lavage is a problem that needs our attention and research. Methods Sleeve gastrectomy and leaks were used as keywords in the Medline search. The retrieved articles were then manually screened, culminating in 29 articles involving 4888 surgeries. The article focuses on the incidence of residual gastric leakage and the factors that influence the leakage. Results In the 4888 cases of sleeve gastrectomy, the incidence of postoperative gastric leakage was 2.4%. The incidence of residual gastric leak was 3.0% (23/771) for patients with super-obesity (BMI> 50), and 2.2% (92/4117) for patients with BMI <50. Stapler staple cartridge height and some edge enhancement methods and can not reduce the gastrocnemius occurred after sleeve gastrectomy. With a 40Fr or more dilator, the incidence of residual gastrectomy after sleeve gastrectomy was 0.6%, while the incidence of residual gastric leak was 2.8% after a small dilator. 89% gastric remnant leakage occurred in the proximal stomach, most of the residual gastric leakage occurs after the first 10 days of surgery. After the occurrence of gastric labrum, placed in the endoscope or laparoscopic placement of the abdominal drainage tube for treatment. Conclusion After gastrosurgical resection, the incidence of residual gastric leak was 2.4%. During gastrectomy, do not get too close to the esophagogastric junction. Once the residual gastric leakage can be treated with minimally invasive method.