残胃容积对腹腔镜胃袖状切除术患者临床结局的影响

Effect of gastric residual antrum size on clinical outcome of laparoscopic sleeve gastrectomy

目的:探讨胃残腔大小对行腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)的病态肥胖患者临床结局的影响。方法:2011年11月—2017年8月对96例病态肥胖患者依据胃残腔容积(即幽门到切除位置的距离)随机分成两组。一组为胃窦保留组(AP-LSG),自幽门到切除位置的距离为6 cm,共49例患者;另一组为胃窦切除组(AR-LSG),距离为2 cm,共47例患者。对两组患者进行至少12个月的术后随访,比较基本特征、超重百分比(%EWL)、体重指数(BMI)降低程度、并发症、死亡率及生活质量。结果:两组在年龄、性别、BMI、并存疾病等方面差异无统计学意义(P>0.05)。1例于术后30d死亡。两组术后并发症发生率差异无统计学意义(P>0.05)。术后6个月及12个月,两组患者体重均明显下降;12个月时,AR-LSG组体重下降较AP-LSG稍明显,但两组间差异无统计学意义(AP-LSG组%EWL为64.2%,AR-LSG组%EWL为67.6%,P>0.05);两组患者在并存疾病的治疗效果、生活质量评估方面差异亦无统计学意义(P>0.05)。结论:LSG手术过程中,无论是否保留较大的胃腔,都会产生明显体重减轻效果;保留胃窦及切除胃窦两种手术方式对于术后超重百分比(%EWL)的降低、并存疾病的治疗及生活质量改善等方面具有同样的效果。

Objective： To study the effect of gastric remnant cavity size on clinical outcome ofLSG patients by statistical analysis of randomized experimental data. Methods： From November 2011 to August 2017, 96 patients with morbidly obese were randomly divided into 2 groups accordingto the size of thegastric residual antrum （which depends on the distance frompyloric to resectionposition）, one group was antralpresservation Group （AP-LSG）, the distance from pyloric to resectionposition was 6cm, and 49 patients were in this group. The other group was the antralresection Group（AR-LSG）, with a distance of 2cm, which composed of 47 patients. After at least 12 months ofpostoperative follow-up, the basic features, the percent excess weight lost （%EWL）, reduction inbody mass index（BMI）, complication, mortality, reoperation and quality of life were statistically evaluatedand analyzed. Results： The two groups were comparable in terms of age, sex, BMI andco-morbidities. Among them, only one mortality in 30-days postoperatively, and there was no significantdifference between the two groups in the complications rate or the early reoperation betweenthe 2 groups. Outcomesat 6 months and 12 months showed that the weight loss was obviousin both groups; At 12 months, the weight loss of AR-LSG group was slightly higher than that ofAP-LSG, but there was no significant difference between the two groups by statistical analysis（%EWL was 64.2%in the AP-LSG group, and %EWL was 67.6%in the AR-LSG Group）; The resolution/improvement of co-morbidities, quality of life assessment and prevalence of integrated diseasewere similar. Conclusion： In the course of LSG, whether or not to retain the larger gastric cavity, itwill produce significant weight loss, the two procedures for the %EWL, the amelioration of co-morbiditiesand quality of life are equally effective.