目的： 探讨贲门左侧胃后壁优先分离四孔法腹腔镜袖状胃切除术的可行性与安全性。方法： 回顾性分析我院2017年1月至2020年5月开展的122例肥胖病或肥胖合并糖尿病病人资料。采用四孔法腹腔镜袖状胃切除术。贲门左侧胃后壁优先分离切开胃胰韧带和部分胃膈韧带。充分暴露胃短血管后离断。再用切割闭合器行常规袖状胃切除,对胃大弯切缘进行缝合加固。结果： 所有病人均顺利完成手术,中位手术时间76(62~117) min,术中出血约20 mL。术后4~5 d顺利出院。术后随访1~42个月,均无术后出血及胃漏并发症发生。结论： 自贲门左侧胃后壁优先分离再离断胃短血管的四孔法腹腔镜袖状胃切除术易游离胃底,对助手要求低,具有临床借鉴价值。

Objective To investigate the feasibility and safety of four ports laparoscopic sleeve gastrectomy (LSG) with preferential dissection of the left cardia and posterior gastric wall. Methods The clinical data of 122 patients including cases with obesity and cases with diabetes mellitus related to obesity who underwent surgery were retrospectively analyzed in our hospital from January 2017 to May 2020. LSG with four ports was performed for all patients. During operation, left cardia and posterior gastric wall were dissected preferentially to incise gastropancreatic ligament and part gastrophrenic ligament. Then short gastric vessels were dissected and cut off carefully. LSG was performed using cutting and closing instruments and the greater curvature of stomach was reinforced with absorbable sutures. Results All the patients completed the operation successfully. Median operative time was 76(62-117) min, and the intraoperative bleeding was about 20 mL. Patients were safely discharged all 4-5 days postoperative and were followed up with the period of duration 1-42 months. There was no postoperative bleeding or gastric leakage complications. Conclusions LSG with four ports in which the left cardia and posterior gastric wall are preferentially dissected and short gastric vessels are cut then have clinical value for easy to dissociate the fundus of stomach and lower technique need of assistant.