三孔法腹腔镜胃袖状切除术治疗肥胖症的疗效分析

doi:10.16139/j.1007-9610.2023.05.12

摘要/Abstract

摘要：

目的：评估三孔法腹腔镜胃袖状切除术（laparoscopic sleeve gastrectomy，LSG）的可行性、安全性和手术疗效。方法：回顾性分析2020年4月至2021年1月间130例行LSG并按时完成随访的肥胖病人临床资料，按手术方式分组，三孔法组52例，四孔法组78例。比较两组围术期情况及术后减重效果。结果：两组均顺利完成LSG，与四孔法组相比，三孔法组平均手术时间更短[(88.35±22.64) min比(98.29±26.25) min，P=0.027），两组术中出血量、术后疼痛、术后引流量、术后住院时间、术后并发症发生情况、术后6个月及2年的减重效果差异均无统计学意义（均P>0.05）。结论：三孔法LSG在不增加手术并发症及手术时间的前提下，可以减少病人手术瘢痕的数量和大小，有利于术后皮肤美观，并获得与四孔法LSG相同的减重疗效，可以作为胃袖状切除术的常规术式。

关键词: 肥胖症, 减重手术, 胃袖状切除术, 腹腔镜, 三孔法

Abstract:

Objective To evaluate the feasibility, safety and efficacy of three-port laparoscopic sleeve gastrectomy(LSG). Methods Clinical data of 130 patients with obesity who underwent LSG from April 2020 to January 2021 and completed follow-up in time were analyzed retrospectively. All patients were divided into two groups as surgical method, there were 52 cases in three-port group and 78 cases in four-port group. Perioperative indicators and improvement of obesity in two groups were compared. Results All procedures were performed via LSG. Compared with four-port group, the mean operative time of three-port group was shorter [(88.35±22.64) min vs. (98.29±26.25) min, P=0.027]. There were no significant differences in amount of bleeding intraoperative, postoperative pain, postoperative drainage, hospital stay after operation, postoperative complication rate and weight loss 6 months and 2 years after surgery (P>0.05). Conclusions Under the premise of no increase in surgical complications and operative time, three-port LSG can reduce the number and size of surgical scars, which is conducive to skin beauty, and obtain the same weight loss effect as four-port LSG, and can be used as a routine operation for sleeve gastrectomy.

Key words: Obesity, Bariatric surgery, Sleeve gastrectomy, Laparoscopy, Three-port method

中图分类号:

R589.2

詹崇文, 沈奇伟, 邵怡凯, 许博, 花荣, 姚琪远. 三孔法腹腔镜胃袖状切除术治疗肥胖症的疗效分析[J]. 外科理论与实践, 2023, 28(05): 463-468.

ZHAN Chongwen, SHEN Qiwei, SHAO Yikai, XU Bo, HUA Rong, YAO Qiyuan. Efficacy of three-port laparoscopic sleeve gastrectomy in treatment of obesity[J]. Journal of Surgery Concepts & Practice, 2023, 28(05): 463-468.

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参考文献 17

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Item	TPLSG (n=52)	FPLSG (n=78)	t(χ²) value	P value
Age (years)	30.02±5.42	28.90±6.77	t=1.000	0.319
Gender （Male/Female）	8/44	29/49	χ²=7.279	0.007
Body mass index (kg/m²)	38.49±6.07	40.29±5.89	t=-1.688	0.094
Waist circumference (cm)	119.61±15.61	126.30±16.08	t=-2.340	0.021
Hip circumference (cm)	123.89±19.73	126.58±12.89	t=-0.935	0.352
Waist-to-hip ratio	1.09±1.04	1.00±0.73	t=0.810	0.42

Item	TPLSG (n=52)	FPLSG (n=78)	t value	P value
Operative time (min)	88.35±22.64	98.29±26.25	-2.234	0.027
Numbers of anastomotic nails	4.96±0.52	5.15±0.51	-2.082	0.039
Intraoperative blood loss (mL)	39.31±20.84	42.14±39.78	-0.39	0.698
Intraoperative complication	0	0

Item	TPLSG (n=52)	FPLSG (n=78)	t value	P value
Pain on operative day(NRS)	2.96±1.60	3.44±2.03	-1.418	0.159
Pain on the first day after surgery (NRS)	2.13±1.37	1.87±1.04	1.242	0.216
Pain on the second day after surgery (NRS)	1.21±0.94	1.29±1.11	-0.447	0.656
Hospital stay after surgery (d)	3.44±1.07	3.63±1.85	-0.656	0.513

Item	TPLSG (n=52)	FPLSG (n=78)	t value	P value
Drainage on operative day (mL)	66.77±48.02	65.40±65.73	0.129	0.897
Drainage on the first day after surgery (mL)	70.15±45.40	83.71±94.90	-0.958	0.34
Drainage on the second day after surgery (mL)	33.29±40.90	37.01±55.31	-0.415	0.678
Total drainage two days after surgery (mL)	170.21±107.74	186.12±183.14	-0.564	0.574

Item	TPLSG (n=52)	FPLSG (n=78)	t(Z) value	P value
Vomit (never/sometimes/ frequently)	31/18/3	45/30/3	Z=-0.115	0.908
Gerd-Q score	6.31±2.27	6.47±2.20	t=-0.115	0.909
Wound complications	0	0