腹腔镜胃袖状切除术后剩余胃体积与减重效果的关系

Relationship between the residual gastric volume and effect of weight loss after laparoscopic sleeve gastrectomy

目的 探讨腹腔镜胃袖状切除术（LSG）后剩余胃体积测量方法,以及术后剩余胃体积与减重效果的关系.方法 回顾性分析2012年6月至2013年10月上海交通大学附属瑞金医院收治的25例肥胖症患者的临床资料.25例患者均行LSG,记录患者术中和术后情况.患者参照2013年国际胃袖状切除术专家共识行围术期处理.术后1、6、12、18个月采用门诊和返院方式,对患者行多学科随访.记录患者的BMI、体质量超出量、多余体质量减少率（EWL）.采用口服碘剂行X线造影检查,并模拟成几何图形评估患者术后剩余胃体积.记录患者术后各随访时间点的剩余胃体积;将患者术后12个月剩余胃总体积、术后第1年（1周至12个月）的剩余胃体积增量与术后18个月的EWL行相关性研究.依据患者术后1周剩余胃底体积分为大胃底组（胃底体积＞ 20 mL）,小胃底组（胃底体积≤20 mL或影像学模型认为胃底已完全切除者）;分析两组患者术后18个月EWL.正态分布的计量资料以-x±s表示,采用t检验;重复测量数据采用重复测量方差分析.多因素之间的相关性分析采用多元线性分析.结果 25例患者均顺利行LSG,手术时间为（180±60） min,术中出血量为（30±20） mL.术中患者未发生大出血、脾破裂等急性手术并发症,术后患者均恢复良好,均未出现吻合口瘘、狭窄、大出血等严重并发症,切口恢复满意.25例患者均获得如期随访,患者术后1年BMI为（29±7）kg/m2,与术前的（39±5）kg/m2比较,差异有统计学意义（F =6.773,P＜0.05）.25例患者术后1周剩余胃总体积为（88±14）mL,胃体（含胃底）体积为（48±10） mL,胃窦体积为（41±9）mL;术后12个月剩余胃总体积为（137 ±23）mL,胃体（含胃底）体积为（70 ± 18） mL,胃窦体积为（67±14）mL.术后1周和术后12个月上述3个指标分别比较,差异均有统计学意义（F=7.122,6.912,7.836,P＜0.05）.25例患者术后第1年（1周至12个月）剩余胃体积增量为（49±26） mL;术后18个月EWL为24％±3％;多元线性分析结果显示：患者术后12个月的剩余胃总体积、术后第1年（1周至12个月）剩余胃体积增量与术后18个月EWL均呈负相关,差异均有统计学意义（r=-0.485,-0.837,P＜0.05）.术后1周大胃底组患者9例,EWL为66％± 13％;小胃底组患者16例,EWL为73％±23％,两组比较,差异无统计学意义（t=0.932,P＞0.05）.结论 患者LSG术后1年内剩余胃体积逐渐增大,患者术后减重效果与术后剩余胃体积、剩余胃体积变化量呈负相关,术后剩余胃底体积与近期减重效果无相关性.

Objective To investigate the measuring method of residual gastric volume and its correlation with the effect of weight loss after laparoscopic sleeve gastrectomy （LSG）.Methods The clinical data of 25 patients with obesity who received LSG at the Ruijin Hospital of Shanghai Jiaotong University between June 2012 and October 2013 were retrospectively analyzed.All the patients received the management during the perioperative period based on the ＆quot;International Sleeve Gastrectomy Expert Panel Consensus Statement （2013）＆quot;,and the intraand post-operative conditions were recorded.All the patients were followed up by outpatient examination and admission to hospital at postoperative month 1,6,12 and 18,and the body mass index （BMI）,excess of body weight and excess weight loss （EWL） rate were recorded.The postoperative residual gastric volumes of patients were estimated by simulating geometry after X-ray radiography using oral iodine.A correlation between the residual gastric volume at postoperative month 12 and increment of residual gastric volume from postoperative week 1 to month 12 and EWL at postoperative month 18 was studied.All the patients were divided into the large fundus group （residual gastric fundus volume 〉20 mL） and the small fundus group （residual gastric fundus volume≤20 mL）.EWL of the 2 groups at postoperative month 18 was analyzed.Measurement data with normal distribution were presented as x ± s and analyzed by the t test,and repeated measurement data were analyzed by the repealed measures ANOVA.Correlation analysis among the multivariate data was done by the multiple linear regression.Results All the 25 patients received successful LSG and regular follow-up with operation time of （180 ± 60）minutes and volume of blood loss of （30 ± 20） mL.All the patients were not complicated with intraoperative hemorrhea and splenic rupture and postoperative anastomotic leakage,stenosis and hemorrhea with the good recovery and satisfaction of incision.BMI at postoperative year 1 was （29 ± 7） kg/m2,which was significantly different from （39 ± 5） kg/m2 before operation （F =6.773,P 〈 0.05）.The residual gastric volume,volume of gastricum （including gastric fundus） and volume of gastric antrum in 25 patients were （88 ± 14）mL,（48 ± 1 0）mL and （41 ± 9）mL at postoperative week 1,（137 ± 23）mL,（70 ±18）mL and （67 ± 14）mL at postoperative month 12,respectively,with significant differences （F =7.122,6.912,7.836,P 〈 0.05）.The increment of residual gastric volume from postoperative week 1 to month 12 and EWL at postoperative month 18 in 25 patients were （49 ±26）mL and 24% ± 3%.The results of multiple linear regression showed that there was a negative correlation between residual gastric volume at postoperative month 12,increment of residual gastric volume from postoperative week 1 to month 12 and EWL at postoperative month 18,with significant differences （r =-0.485,-0.837,P 〈 0.05）.Nine patients were detected in the large fundus group with EWL of 66% ± 13% and 16 patients in the small findus group with EWL of 73% ± 23%,showing no significant difference （t =0.932,P 〉 0.05）.Conclusion The residual gastric volume of patients is increased gradually within postoperative year 1.There is a negative correlation between the effect of postoperative weight loss and the postoperative residual gastric volume and increment of residual gastric volume,and no obvious correlation between the postoperative volume of residual gastric fundus and short-term effect of weight loss.