胃残余经纵隔疝出：腹腔镜袖状胃切除术后一种罕见并发症

文献信息

中文摘要

鉴于代谢减重手术在疗效和成本效益方面均优于传统治疗，其应用预计将在未来日益增多。因此，熟练掌握相关并发症的识别与处理已成为日常临床实践中的一项关键能力。腹腔镜袖状胃切除术因其标准化的手术技术、良好的临床结局和有利的安全性特征，仍是最常见的减重手术方式。本报告详述了一例患者，其在袖状胃切除术后四年内一直无症状，随后新发严重的胃食管反流病和吞咽困难。通过钡餐吞咽检查和内镜检查，发现近端胃残余呈囊状膨出，经膈肌疝入纵隔，导致远端食管受压。遂行腹腔镜修正手术，包括切除增大的胃底并修补食管裂孔疝。鉴于患者反流症状严重，手术由袖状胃切除术转为Roux-en-Y胃旁路术。术后过程平稳，患者随后出院。修正手术后，患者症状缓解，体重保持稳定。由于腹腔镜袖状胃切除术后吞咽困难可能由多种病因引起，精确的鉴别诊断对于确定最终治疗方式至关重要。Orv Hetil. 2026; 167(37): 1488-1492。

英文摘要

Given that metabolic-bariatric surgery outperforms traditional treatments in both efficacy and cost-efficiency, its prevalence is expected to grow in the future. Accordingly, proficiency in identifying and managing associated complications becomes a critical competency in everyday clinical practice. Laparoscopic sleeve gastrectomy remains the most prevalent bariatric procedure due to its standardized surgical technique, excellent clinical outcomes, and favorable safety profile. The report details a case in which a patient, who had previously been symptom-free for four years after sleeve gastrectomy, developed newly onset severe gastro-esophageal reflux disease and dysphagia. Diagnostic evaluation via barium swallow and endoscopy revealed a saccular eventration of the proximal gastric remnant, which had herniated through the diaphragm into the mediastinum, resulting in extrinsic compression of the distal esophagus. A laparoscopic surgical revision was performed, involving resection of the enlarged gastric fundus and repair of the hiatal hernia. Given the severity of the patient's reflux symptoms, the procedure was converted from sleeve gastrectomy to a Roux-en-Y gastric bypass. The postoperative course was uneventful, and the patient was subsequently discharged. After the revisional surgery, the patient's symptoms subsided, and her weight remained consistent. As dysphagia following laparoscopic sleeve gastrectomy may arise from diverse etiologies, precise differential diagnosis is essential for determining the definitive treatment modality. Orv Hetil. 2026; 167(37): 1488-1492.