三孔法腹腔镜胃袖状切除术治疗肥胖症的临床疗效

Clinical efficacy of three-port laparoscopic sleeve gastrectomy for obesity

目的探讨三孔法腹腔镜胃袖状切除术（TLSG）治疗肥胖症的可行性、安全性及临床疗效。方法采用回顾性横断面研究方法。收集2016年9月至2017年3月首都医科大学附属北京友谊医院收治的104例肥胖症患者临床资料。104例患者均由同一手术团队施行TLSG。观察患者手术施行情况、中转情况（增加戳孔或中转开腹）、手术时间、术中出血量、手术相关并发症、术后住院时间及随访情况。采用微信、电话及住院方式进行随访。术后第3、6、9、12个月分别随访1次，术后1年后每年随访1次。随访内容为减重疗效及术后长期并发症发生情况。随访时间截至2017年4月。正态分布的计量资料以觉±s或平均数（范围）表示。结果104例患者均成功施行TLSG，无增加戳孔或中转开腹。手术时间为（121±25）min，术中出血量为（9±6）mL，无术中严重副损伤发生。104例患者中，术后肚脐戳孔感染1例、腹腔积液继发感染1例、因不当进食诱发急性胃排空障碍3例、戳孔脂肪液化6例、戳孔延迟愈合9例，均经对症支持治疗后痊愈。全组患者术后无消化道出血、腹腔出血及胃漏等严重并发症发生；术后住院时间为（2．4±0．8）d。82例患者获得3个月（3～6个月）随访，其中59例随访满3个月，23例随访满6个月；22例随访未满3个月．随访期间患者无戳孔疝发生。随访满3个月的59例患者多余体质量减少率（EWL）为37％±11％，随访满6个月的23例患者EWL为45％±13％。随访满3个月的59例患者中，14例糖尿病均停用降糖药物，10例糖化血红蛋白完全缓解，4例糖化血红蛋白部分缓解。随访满6个月的23例患者中，糖尿病6例，糖化血红蛋白均完全缓解。18例重度阻塞睡眠呼吸暂停低通气综合征（OSAHS）患者中，4例随访满3个月，其中3例完全缓解，1例缓解至轻度OSAHS：其余14例尚未达随访时间未行评估。结论TLSG治疗适应证范围内肥胖症安全可行，短期临床效果良好，可减少戳孔数目兼顾美容效果。

Objective To investigate the feasibility, safety and clinical efficacy of three-port laparoscopic sleeve gastreetomy （TLSG）. Methods The retrospective cross-sectional study was conducted. The clinical data of 104 obese patients who were admitted to the Beijing Friendship Hospital of Capital Medical University between September 2016 and March 2017 were collected. TLSG was performed to all the 104 patients by the same surgical team. The surgical situations, conversion situations （port-site increased or conversion to open surgery） , operation time, volume of intraoperative blood loss, surgery-related complications, duration of postoperative hospital stay and follow-up situations were observed. Patients were followed up by Wechat, telephone interview and inpatient examination once at month 3, 6, 9 and 12 postoperatively and once every year aler 1 year postoperatively up to April 2017. Follow-up included weight-loss efficaey and postoperative long-term complications. Measurement data with normal distribution were represented as x＋s or average （range）. Resolts All the 104 patients underwent successful TLSG, without port-site increased or conversion to open surgery. Operation time and volume of intraoperative blood loss were （121±25）minutes and （9±6）mL, respectively. There was no severe intraoperative collateral damage. All the 104 patients with complications were cured by symptomatic treatment, including 1 with port-site infection, I with peritoneal effusions causing secondary infection, 3 with improper eating-induced acute delayed gastric emptying, 6 with fat liquefaction around port-site and 9 with delay healing of port-site. There wasno occurrence of severe complications, such as gastrointestinal bleeding, intra-abdominal bleeding and gastrostoma. Duration of postoperative hospital stay was （2.4±0.8）days. Eighty-two patients were followed up for 3 months （range, 3-6 months）, including 59 with 3-month follow-up, 23 with 6-month follow-up and 22 with under 3-month follow-up. During the follow-up, there was no port-site hernia. Excess weight loss （EWL） was 37%± 11% in 59 patients with 3-month follow-up and 45%± 13% in 23 patients with 6-month follow-up. Of 59 patients with 3-month follow-up, 14 patients with diabetes mellitus stopped taking antidiabetic drugs, 10 of 14 patients had complete remission （CR） of hemoglobin Alc （HbAlc） and 4 of 14 patients had partial remission （PR） of HbAlc. Of 23 patients with 6-month follow-up, 6 patients with diabetes mellitus had CR of HbAlc. Of 18 patients with obstructive sleep apnea hypopnea syndrome （OSAHS） , 4 had 3-month follow-up, including 3 with CR and 1 was improved to mild OSAHS. Other 14 patients were not evaluated due to inadequate follow-up time. Conclusion TLSG for obese patients with specific indications cannot increase operation time and risk, meanwhile, it can reduce port-site, with a good cosmetic effect.