腹腔镜胃旁路术胃肠吻合方法比较及并发症预防

Gastrointestinal anastomosis in laparoscopic gastric bypass and prevention of complications

目的 :比较腹腔镜胃肠旁路手术的小胃囊前壁和后壁与空肠吻合两种方法的差异性,探索安全有效的胃肠吻合方法以及胃肠吻合口并发症的预防。方法:2010年5月至2013年6月我科完成腹腔镜下胃旁路手术150例,所有手术都有完整的录像,病人病历资料完整,术后定期随访,计算每例病人行胃肠吻合所需时间,统计术后1年过多体重下降率,以及术后的并发症发生情况等。结果:150例中有1例病人中转开腹,但在腹腔镜下完成胃肠吻合,27例病人行小胃囊前壁与空肠吻合,123例行小胃囊后壁吻合。前、后壁吻合两组性别、体质量指数和手术时间上无统计学差异(P>0.05),在术后1年减重效果、术后营养不良及并发症上无统计学差异(P>0.05)。但在手术开展初期,50例中11例前壁吻合和39例后壁吻合手术时间有统计学差异[(23.5±11.6)min比(12.8±19.0)min,P<0.05]。术后发生胃肠吻合口溃疡、穿孔2例,狭窄1例。结论:小胃囊前、后壁与空肠吻合在减重效果及术后并发症等方面无统计学差异,在手术发展初期阶段小胃囊后壁与空肠吻合手术时间较短。胃肠吻合口狭窄可通过胃镜扩张治疗,吻合口溃疡重在预防。

Objective To compare posterior anastomosis with anterior anastomosis of small gastric pouch with jejunum in laparoscopic gastric bypass and to study the safe and effective gastrointestinal anastomosis to prevent the anasto- motic complications. Methods From May 2010 to June 2013, 150 cases of laparoscopic Roux-en-Y bypass had been performed in our department. All operations were reserved completed video with intact medical records and regular follow-up for all the patients. The operation time of gastrointestinal anastomosis, excess weight loss rate （EWL%） after 1 year, and postoperative complications were analyzed. Results One case was converted to open surgery with laparoscopie gastrointestinal anastomosis. Totally there were small pouch anterior anastomosis in 27 patients and posterior anastomosis 123 cases. Between two groups, there was no significant difference in terms of gender, body mass index, and operation time （P〉 0.05）, and no difference in EWL of 1 year, malnutrition and the complications postoperatively （P〉0.05）. In the early stage, however, 11 cases had anterior wall anastomosis and 39 cases posterior wall anastomosis. There was significant difference in the operation time of gastrointestinal anastomosis between anterior anastomosis （23.5±11.6 min） and posterior anastomosis （12.8±19.0 min） （P〈0.05）. Gastric ulcer perforation occurred in 2 cases, stenosis in 1 case. Conclusions There was no significant difference in EWL and postoperative complications between two anastomosis methods. Anastomosis time was shorter in the posterior wall at the beginning of learning curve. Gastrointestinal anastomotie stenosis can be treated by endoscopic dilation. It is important to prevent anastomotic ulcer.