腹腔镜胃旁路术结肠前与结肠后胃空肠吻合术的前瞻性比较研究

Antecolic versus retrocolic gastroenteric anastomosis for laparoscopic Roux-en-Y gastric bypass： a prospective randomized control trial

目的比较腹腔镜Roux-en—Y胃旁路术（LRYGB）治疗肥胖症术中结肠前与结肠后两种胃空肠吻合术式的疗效差异。方法前瞻性地将2008年3月至2010年7月暨南大学附属第一医院收治的40例肥胖症患者按随机数字表法分为结肠前组（20例）和结肠后组（20例）。比较两种术式术中、术后恢复情况及短期消化道症状。结果所有病例均顺利完成手术。两组术中失血量、术后排气时间、进食半流时间及术后住院时间方面的差异均无统计学意义（均P〉0．05）；但结肠后组手术时间明显长于结肠前组[（163．4±28．1）min比（131．8±22．7）min，P〈0．05]。两组均未出现腹内疝及吻合口瘘等并发症；术后3个月，两组患者消化道症状的差异亦无统计学意义（P〉0．05）。结论尽管LRYGB结肠后胃空肠吻合更加符合生理结构．但在术后短期疗效上结肠前与结肠后吻合术相当．其远期效果有待进一步研究证实。

Objective To compare short-term postoperative outcomes between antecolic and retroeolic laparoscopic Roux-eu-Y gastric bypass （LRYGB）. Methods Forty obesity patients were admitted into The First Affiliated Hospital of Jinau University from March 2008 to July 2010. All patients were randomly assigned to undergo anteeolic （group A, 20 cases） and retroeolie （group B, 20 cases） gastroenteric anastomosis. Short-term outcomes were compared. Results LRYGB procedures were successfully performed in all the 40 patients. There were no significant differences between the two groups in estimated blood loss during surgery, time to flatus passage, time to resumption of oral intake, or length of postoperative hospital stay. The operation time was longer in group B than that in group A [ （163.4±28.1） min vs. （131.8±22.7） min, P〈0.05] There were no patients developed internal hernia or anastomotic leakage in either group. Comparison of short-term gastrointestinal symptoms after surgery showed no statistical significance. Conclusions Although retrocolic procedure may be closer to anatomical structure, antecolic and retrocolic anastomosis have comparable short-term outcomes after surgery. Further study is warranted to investigate long-term outcomes.