外科理论与实践 ›› 2023, Vol. 28 ›› Issue (05): 463-468.doi: 10.16139/j.1007-9610.2023.05.12
詹崇文, 沈奇伟, 邵怡凯, 许博, 花荣(), 姚琪远(
)
收稿日期:
2023-03-07
出版日期:
2023-09-25
发布日期:
2024-01-04
通讯作者:
姚琪远,E?mail:stevenyao@huashan.org.cn;花荣,E?mail:blossom875@sina.com
基金资助:
ZHAN Chongwen, SHEN Qiwei, SHAO Yikai, XU Bo, HUA Rong(), YAO Qiyuan(
)
Received:
2023-03-07
Online:
2023-09-25
Published:
2024-01-04
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。
中图分类号:
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.
表1
病人一般资料比较[$\bar{x} \pm s$/n(%)]
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 |
表3
术后疼痛及住院时间 ($\bar{x} \pm s$)
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 |
表4
术后引流量($\bar{x} \pm s$)
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 |
[1] | 中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南(2019版)[J]. 中国实用外科杂志, 2019, 39(4):301-306. |
Thyroid and Metabolism Surgery Group of the Chinese Society of Surgery, Chinese Society for Metabolic and Bariatric Surgery. Guidelines for surgical treatment of obesity and type 2 diabetes in China (2019)[J]. Chin J Pract Surg, 2019, 39(4):301-306. | |
[2] | 中国营养学会肥胖防控分会, 中国营养学会临床营养分会, 中华预防医学会行为健康分会, 等. 中国居民肥胖防治专家共识[J]. 中华流行病学杂志, 2022, 43(5):609-626. |
Chinese Nutrition Society Obesity Prevention and Control Section Chinese Nutrition Society Clinical Nutrition Section, Chinese Preventive Medicine Association Behavioral Health Section, et al. Expert consensus on obesity prevention and treatment in China[J]. Chin J Epidemiol, 2022, 43(5):609-626. | |
[3] |
GAGLIESE L, WEIZBLIT N, ELLIS W, et al. The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients[J]. Pain, 2005, 117(3):412-420.
doi: 10.1016/j.pain.2005.07.004 pmid: 16153776 |
[4] |
LI N, XU B, ZENG J, et al. Development of a new index based on preoperative serum lipocalin 2 to predict post-LSG weight reduction[J]. Obes Surg, 2022, 32(4):1184-1192.
doi: 10.1007/s11695-022-05916-1 pmid: 35138515 |
[5] |
ANGRISANI L, SANTONICOLA A, IOVINO P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures[J]. Obes Surg, 2018, 28(12):3783-3794.
doi: 10.1007/s11695-018-3450-2 pmid: 30121858 |
[6] |
KHIDIR N, GAGNER M, EL MATBOULY M, et al. Single-port sleeve gastrectomy compared with conventional laparoscopic sleeve gastrectomy: 5-year follow-up of weight loss, comorbidity resolution, and cost[J]. Surg Innov, 2020, 27(3):265-271.
doi: 10.1177/1553350620902550 pmid: 32008415 |
[7] |
PARK Y, PARK Y S, LEE S, et al. Safety and effectiveness of reduced-port laparoscopic sleeve gastrectomy in Asian morbidly obese patients[J]. Sci Rep, 2021, 11(1):23511.
doi: 10.1038/s41598-021-02999-1 pmid: 34873253 |
[8] |
MAURIELLO C, CHOUILLARD E, D’ALESSANDRO A, et al. Retrospective comparison of single-port sleeve gastrectomy versus three-port laparoscopic sleeve gastrectomy: a propensity score adjustment analysis[J]. Obes Surg, 2018, 28(7):2105-2112.
doi: 10.1007/s11695-018-3244-6 |
[9] |
TRANCHART H, REBIBO L, GAILLARD M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis[J]. Surg Endosc, 2020, 34(9):3978-3985.
doi: 10.1007/s00464-019-07175-1 |
[10] |
CONSALVO V, SALSANO V, SARNO G, et al. Three-trocar sleeve gastrectomy vs standard five-trocar technique: a randomized controlled trial[J]. Obes Surg, 2017, 27(12):3142-3148.
doi: 10.1007/s11695-017-2760-0 URL |
[11] | Pan H M, Liao G S, Lin C H, et al. A practically modified approach with complete posterior mobilization for three-port sleeve gastrectomy: single-center experience[J]. Surg Laparosc Endosc Percutan Tech, 2022, 32(5):627-630. |
[12] | 沈佳慧, 杨珵璨, 王文越, 等. 三孔法在腹腔镜胃袖状切除术中的应用[J]. 外科理论与实践, 2018, 23(6):515-518. |
SHEN J H, YANG C C, WANG W Y, et al. Three-port approach for laparoscopic sleeve gastrectomy[J]. J Surg Concepts Pract, 2018, 23(6):515-518. | |
[13] |
ALHAMBRA-RODRÍGUEZ DE GUZMÁN C, MORANDEIRA-RIVAS A J, HERRERO-BOGAJO M L, et al. Incidence and risk factors of incisional hernia after single-incision endoscopic surgery[J]. J Laparoendosc Adv Surg Tech A, 2020, 30(3):251-255.
doi: 10.1089/lap.2019.0728 URL |
[14] |
LAINAS P, DERIENNE J, DAMMARO C, et al. Single-port laparoscopic surgery for the treatment of severe obesity: review and perspectives[J]. Obes Surg, 2020, 30(7):2781-2790.
doi: 10.1007/s11695-020-04620-2 pmid: 32318996 |
[15] | 姜海军, 宫轲. 单孔腹腔镜手术进展与未来[J]. 中国微创外科杂志, 2010, 10(1):37-40. |
JIANG H J, GONG K. Progress and future of single-port laparoscopic surgery[J]. Chin J Min Inv Surg, 2010, 10(1):37-40. | |
[16] | 张丛荣, 张志强, 朱安龙. 腹腔镜手术基本操作原则[J]. 中国实用外科杂志, 2019, 39(4):394-396. |
ZHANG C R, ZHANG Z Q, ZHU A L. Basic operating principles of laparoscopic surgery[J]. Chin J Pract Surg, 2019, 39(4):394-396. | |
[17] | 王博方, 马臻, 汪学艳, 等. 腹腔镜下肝脏悬吊方法进展[J]. 中华普通外科杂志, 2020, 35(2):171-173. |
WANG B F, MA Z, WANG X Y, et al. Progress in techniques for retraction of the liver[J]. Chin J Gen Surg, 2020, 35(2):171-173. |
[1] | 燕速, 郑民华. 中国单孔及减孔腹腔镜胃癌手术实践[J]. 外科理论与实践, 2023, 28(03): 233-239. |
[2] | 骆洋, 俞旻皓, 叶光耀, 林海萍, 贡婷月, 李浩, 钟鸣. 术中吲哚菁绿荧光显像评估在降低腹腔镜直肠癌术后吻合口漏的应用价值[J]. 外科理论与实践, 2023, 28(03): 249-253. |
[3] | 郑民华, 马君俊. 中国腹腔镜结肠直肠手术30年:我们学到了什么[J]. 外科理论与实践, 2023, 28(03): 181-185. |
[4] | 高攀, 蔡云强, 彭兵. 保留功能的腹腔镜胰头部及十二指肠乳头肿瘤切除手术[J]. 外科理论与实践, 2023, 28(03): 190-196. |
[5] | 骆洋, 钟鸣. 腹腔镜低位直肠癌前切除术吻合口漏的预防和治疗[J]. 外科理论与实践, 2023, 28(03): 220-225. |
[6] | 朱斯维, 尹新民. 腹腔镜肝门部胆管癌根治术的现状与思考[J]. 外科理论与实践, 2023, 28(02): 100-103. |
[7] | 张诚, 杨玉龙. 从胆胰管汇合部疾病分析认识胆石病的内镜治疗[J]. 外科理论与实践, 2023, 28(02): 119-123. |
[8] | 姚立彬, 洪健, 侯栋升, 朱孝成. 腹腔镜袖状胃切除+双通路吻合术手术流程与技术要点[J]. 外科理论与实践, 2023, 28(02): 157-161. |
[9] | 杨良根, 朱俊强, 胡星辰. 腹腔镜经腹腹膜前疝修补术治疗嵌顿性腹股沟疝[J]. 外科理论与实践, 2022, 27(06): 551-554. |
[10] | 叶雅芬, 杨颖, 韩峻峰. 脂肪组织衰老的细胞学改变及其分子机制研究进展[J]. 诊断学理论与实践, 2022, 21(05): 650-654. |
[11] | 秦伟, 胡延岩, 徐玺谟, 蔡正昊, 李健文, 龚昆梅, 冯波. 中低位直肠癌经肛门与腹腔镜全直肠系膜切除术后近期疗效荟萃分析[J]. 外科理论与实践, 2022, 27(05): 435-442. |
[12] | 聂明明, 朱正纲. 腹腔镜探查对进展期胃癌精准分期的临床意义[J]. 外科理论与实践, 2022, 27(04): 365-370. |
[13] | 郭良奇, 严志龙, 张谋成. 腹腔镜经胃腔手术治疗胃黏膜下肿瘤和早期胃癌[J]. 外科理论与实践, 2022, 27(04): 380-383. |
[14] | 满高亚, 党同科, 吴清松, 冯飞灵. Rouviere沟引导胆囊后隧道解剖用于困难腹腔镜胆囊切除术[J]. 外科理论与实践, 2022, 27(03): 239-243. |
[15] | 宣呈杰, 卞冬生, 蒋咏梅, 陈宇菲, 金佳斌, 施咏梅. 营养治疗对减重术后身体成分及静息能量消耗的影响[J]. 外科理论与实践, 2022, 27(03): 244-248. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||