腹腔镜袖状胃切除术的围手术期处理

Perioperative managment of laparoscopic sleeve gastrectomy

目的总结腹腔镜袖状胃切除术（LSG）治疗病态性肥胖症患者的疗效及其围手术期处理方法。方法回顾性分析2010年5月至2012年12月在第二军医大学长海医院行LsG手术、并获得至少1年术后随访的57例病态性肥胖症患者的临床资料。所有患者均予以充分的术前准备和严格的术后管理．并通过随访了解其术后额外体质量减轻百分率（EWL％）和术前合并症的缓解情况。结果除1例因腹腔广泛粘连中转开腹，其余56例患者均在腹腔镜下完成手术。手术时间（102．0±15．2）min，术中出血（132．3±45．6）ml。无围手术期死亡患者，无吻合口瘘、吻合口狭窄及切口感染发生。术后出血2例。其中1例经输血和止血药等保守治疗止血，另1例行再次腹腔镜探查止血。全组患者术后3、6和12月，EWL％分别为（54．9±13．8）％、（79．0±23．6）％和（106．9±25．1）％，且术前合并症均获得了不同程度的缓解或改善。结论LSG对肥胖症有良好的临床治疗效果，通过加强围手术期管理．可以提高手术安全性和术后疗效。

Objective To summarize the surgical technique and perioperative management of laparoscopic sleeve gastrectomy （LSG）. Methods A total of 57 morbid obesity patients undergoing LSG surgery from May 2010 to December 2012 were enrolled in the study, whose clinical data in perioperative period were analyzed retrospectively. These patients had more than 1 year of follow-up. All the patients received preoperative preparation and postoperative management, and postoperative excess weight loss （EWL%） and improvement of preoperative complications was evaluated. Results All the cases completed the operation under laparoscopy, except 1 case because of the abdominal extensive adhesion. The average operation time was （102.0＋15.2） min and the mean intraoperative blood loss （132.3＋45.6） ml. Of 2 postoperative hemorrhage patients, l case received conservative treatment, and another one underwent laparoscopic exploration. The EWL% at 3 months, 6 months and 1 year after procedure was （54.9＋13.8）%, （79.0＋23.6）% and （106.9_＋25.1）% respectively. The preoperative complications were improved in some degree. There were no operative death, and anastomotic leak, anastomotic stenosis, or surgical site infection occurred. Conclusion LSG is a safe and effective surgical technique, whose safety and efficacy may be increased by improving the perioperative management.