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在Roux-en-Y胃绕道术后的晚期边缘穿孔 - 一个病例报告与两步管理
Nina Pfeifer1, Thomas Steffen1, Larissa Clea Vines2
1Department of General, Visceral, Endocrine and Transplant Surgery & Bariatric Surgery Center of Eastern Switzerland, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
一种两步手术方法有效地治疗了Roux-en-Y胃旁路术后的穿孔边缘,在一个败血症患者身上. 这种方法涉及初始的损害控制手术,随后是延迟的重建,对于重症患者来说证明是可行的.
科学领域:
- 腹部外科 腹部外科
- 胃肠病学 胃肠病学
- 手术病例报告 手术病例报告
背景情况:
- 边缘是一种已知的Roux-en-Y胃绕道 (RYGB) 的并发症.
- 这些的急性穿孔很少见,手术管理策略的记录有限.
- 这份报告详细介绍了一个患有败血症的患者穿孔边缘的病例.
研究的目的:
- 在RYGB后的败血症患者中,为穿孔边缘提供一种可行的两步手术治疗方法.
- 突出针对边缘孔的复杂病例的量身定制方法.
主要方法:
- 一名39岁的患者,RYGB后六年,由于穿孔边缘而出现败血症.
- 最初的手术涉及因患者不稳定性和广泛的穿孔而造成的损害控制的断续续切除.
- 采用了分阶段的方法,在患者稳定和营养改善后,在9周后恢复胃肠.
主要成果:
- 这种两步程序成功地治疗了穿孔边缘和败血症.
- 在重建手术之前,患者的稳定和营养增强得到了实现.
- 在第二阶段成功地进行了胃结节术的恢复.
结论:
- 边缘的治疗,特别是穿孔,缺乏明确的指导方针,通常需要个性化的手术策略.
- 一个分阶段的方法,包括损伤控制手术,然后是选择性重建,对于患有RYGB后穿孔边缘的重症患者来说,这是一个可行的选择.
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