减肥手术并发症的生物治疗

A. Khitaryan, A. Mezhunts, K. S. Oplimakh, A. Orekhov, D. Melnikov, S. A. Adizov, V. N. Kislyakov, A. A. Abovyan
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引用次数: 0

摘要

近年来,实施减肥手术的数量大幅增加。尽管这种治疗方法非常有效,但并发症的发生并不少见。最常见的并发症是缝合线渗漏,发生率为 1.5-2.4%;单吻合胃旁路术后吻合口渗漏--发生率为 2.2-8% 。所有方法的问题都在于治疗时间延长,需要长时间不进食,这就意味着要开始肠外营养,面临营养不良的风险。文章通过一系列临床病例证明了生物疗法对减肥手术并发症的有效性。文章描述了 2 例单次吻合胃旁路术后吻合口漏的患者的临床病例,以及 2 例腹腔镜袖带胃切除术后缝合线失效的患者的临床病例。采用了富血小板血浆疗法、基质血管成分(SVF)和纤维蛋白胶。富血小板血浆是一种自体血清,含有高浓度的血小板和生长因子。结果,经过 4 个疗程的富血小板血浆治疗后,订书机线上部三分之一失败的患者接受了双组分纤维蛋白胶 "Kriofit "的应用,并取得了积极的效果。此外,使用三组份疗法治疗吻合口渗漏的患者也观察到了积极的动态效果。基于上述事实,可以得出结论,生物疗法在治疗减肥手术并发症(如缝合线渗漏和吻合口渗漏)方面具有巨大的潜在价值。
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Biological therapy of bariatric surgery complications
In recent years, the number of performed bariatric interventions has increased significantly. Despite the high effectiveness of this method of treatment, the occurrence of complications is not uncommon. The most common complications are stapler line leaks, occurring in 1.5–2.4% of cases; anastomotic leakage after One Anastomosis Gastric Bypass – in 2.2–8% of cases. The problem with all methods is the increased duration of treatment and the need to go without food for significant periods of time, which means starting parenteral nutrition and risking malnutrition. The article demonstrates the effectiveness of biological therapy for complications of bariatric surgery in a series of clinical cases. Clinical cases of 2 patients with anastomotic leakage after One Anastomosis Gastric Bypass are described; also 2 patients with incompetent staple line after laparoscopic Sleeve Gastrectomy. PRP therapy, stromal vascular fraction (SVF) and fibrin glue were used. Platelet-rich plasma is an autologous blood serum containing high concentrations of platelets and growth factors. As a result, after 4 courses of PRP therapy, the patient with the failure of the upper third of the stapler line received an application of twocomponent fibrin glue “Kriofit” with a positive effect. In addition, positive dynamics was observed in the patient with the use of threecomponent therapy of anastomotic leakage. Based on the above facts, it can be concluded, that biological therapy demonstrates great potential value in the treatment of bariatric surgery complications such as stapler line leaks, and anastomotic leakage.
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