既往腹部手术史对腹腔镜Roux-en-Y胃旁路术的影响

The effect of abdominal surgery history on laparoscopic Roux-en-Y gastric bypass

目的:总结腹部手术史患者行腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)的可行性及安全性。方法:回顾分析2011年1月至2013年10月89例LRYGB患者的资料。根据有无腹部手术史将患者分为腹部手术史组(n=19)与无腹部手术史组(n=70)。评估两组患者性别、年龄、美国麻醉医师协会(American Society of Anesthesiologists,ASA)病情分级、腹腔粘连发生率及粘连松解率、手术时间、术中失血量、中转开腹率、术中及术后并发症发生率、住院时间等指标。结果:无腹部手术史组与腹部手术史组患者术中发现腹腔粘连率分别为7.1%与73.7%,其中需松解率分别为0与71.4%,无因松解粘连引发的并发症。腹部手术史组女性患者所占比例、ASA分级及年龄较无腹部手术史组高(P<0.05),腹部手术史与增加的手术时间、住院时间有关(P<0.05)。两组患者术中失血量、中转开腹率、术中与术后并发症发生率差异无统计学意义(P>0.05)。结论:腹部手术史并非LRYGB的手术禁忌证。然而有腹部手术史的患者往往年龄、ASA分级高,增加了手术风险,且术中粘连松解率较高,手术时间、住院时间较长。

Objective：To evaluate the feasibihty and safety of laparoscopic Roux-en-Y gastric bypass （LRYGB） on patients with abdominal surgery history. Methods：The data of 89 patients who underwent LRYGB from Jan. 2011 to Oct. 2013 were retrospectively analyzed. Patients were classified into 2 groups. Group 1 included 19 patients with abdominal surgery history, Group 2 included 70 patients without abdominal surgery history. Patients＇ gender, age, American Society of Anesthesiologists （ASA） patient classification, presence of adhesions rate, rate of adhesiolysis required, operation time, estimated blood loss, transfusion rate, conversion rate, intraoperative and postoperative complication rate and length of hospital stay were evaluated in each patient. Results：Adhesions were found in 14 patients of Group 1 （73.7%） and 5 patients of Group 2 （7.1%） with the rate of adhesiolysis required 71.4% and 0% ,respectively. No complications were found during adhesiolysis. The percentage of females, ASA classification and age were significantly higher in Group 1 than Group 2 （ P 〈 0.05 ）. Patients with abdominal surgery history had a longer operation time and postoperative hospital stay （P 〈 0.05 ）. No significant differences were observed in operative blood loss, rate of conversion to an open procedure and complication rate. Conclnsions：h is safe for patients with abdominal operation history to undergo LRYGB. However, the patients with abdominal surgery history tends to be older with higher ASA classification and operation risk which lead to increased need for adhesiolysis,prolonged operation time and longer postoperative hospital stay.