三孔腹腔镜胃袖状切除术:附18例报告

Three-port Laparoscopic Sleeve Gastrectomy: Experience of 18 Cases

目的探讨三孔法腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)的可行性,总结手术经验。方法回顾性分析2017年5月~2018年3月三孔法LSG治疗18例肥胖患者的临床资料及随访结果。BMI 29.10~49.93,38.46±11.56。合并2型糖尿病7例。观察孔位于脐或脐上,主操作孔位于右锁骨中线与肋缘交界处,辅助操作孔位于剑突下2 cm。克氏针于剑突下方刺入,腹腔镜监视下经肝左外叶脏面插入右侧膈肌脚,即"克氏针挡肝技术"。结果 18例手术均顺利完成,手术时间(82.8±47.0)min,术中出血量5~120 ml,术后住院(4.0±2.6)d。术后1~2个月随访,无出血、胃漏、脐疝等并发症。结论三孔法LSG安全性、可行性值得肯定。克氏针挡肝技术对实现减孔至关重要。

Objective To explore the feasibility of three-port laparoscopic gastric sleeve gastrectomy（ LSG） and summarize the surgical experience. Methods The clinical data and follow-up results of 18 obese patients from May 2017 to March 2018 were analyzed retrospectively. Their BMI was 29. 10-49. 93（ mean,38. 46 ± 11. 56）. There were 7 cases of type 2 diabetes mellitus（ T2 DM）. The optical port was placed on the umbilicus or above the umbilicus,the main operation port was located at the junction of right midclavicular line and right costal margin,and the last 5-mm trocar was located at 2 cm under the xiphoid. Under the laparoscopic surveillance,a Kirschner wire was inserted under the xiphoid. Through the undersurface of the left lateral lobe of the liver,the Kirschner wire finally was inserted into the right diaphragmatic foot. This also was called the technology of ＂fending off the liver by Kirschner wire＂. Results The operations were successfully performed in all the 18 patients. The operation time,bleeding volume,and duration of postoperative stay were（ 82. 8 ± 47. 0） min,5-120 ml,and（ 4. 0 ± 2. 6） d,respectively. The bleeding,gastric leakage,or umbilical hernia was not observed at follow-ups for 1-2 months. Conclusions Three-port laparoscopic sleeve gastrectomy is safe and feasible. The technology of ＂fending off the liver by Kirschner wire ＂is an effective method in three-port laparoscopic sleeve gastrectomy.