达芬奇机器人辅助Roux-en-Y胃旁路术在肥胖症治疗中的应用价值

Application value of Da Vinci robot-assisted Roux-en-Y gastric bypass in treating obesity

目的探讨达芬奇机器人辅助Roux-en-Y胃旁路术(RRYGB)在肥胖症治疗中的应用价值。方法回顾性分析2012年7月至2016年11月在华中科技大学同济医学院附属协和医院胃肠外科接受代谢手术治疗的9例肥胖症患者的临床资料。所有患者均签署知情同意书,符合医学伦理学规定。根据是否接受机器人辅助治疗,患者被分为RRYGB组和腹腔镜Roux-en-Y胃旁路术(LRYGB)组。其中RRYGB组3例,男1例,女2例;年龄(37±7)岁。LRYGB组6例,男3例,女3例;年龄(31±7)岁。比较两组患者的手术时间、术中出血量、术后通气时间、术后住院时间,术前和术后1个月的体质量、体质指数(BMI)、空腹血糖(FPG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、甘油三酯(TG)和总胆固醇(TC)水平。两组临床指标的比较采用独立样本t检验或χ2检验。结果所有患者均成功完成手术治疗。RRYGB组患者的术中出血量为(46±7)ml,明显少于LRYGB组的(82±6)ml(t=–8.03,P<0.05)。术后1个月,RRYGB和LRYGB组患者的BMI水平分别为(34±5)和(35±4)kg/m2,均明显低于术前的(39±7)和(40±5)kg/m2(t=5.33、7.33,P<0.05),两组患者的BMI减少量比较差异无统计学意义(t=0.35,P>0.05)。结论 RRYGB治疗肥胖症的短期效果良好,但由于本研究纳入例数过少,随访时间不足,故其安全性和有效性有待于进一步研究以明确。

Objective To investigate the clinical application value of robot-assisted Roux-en-Ygastric bypass(RRYGB)in treating obesity.Methods Clinical data of9obese patients undergoing bariatricsurgery in Xiehe Hospital Affiliated to Tongji Medical College of Huazhong University of Science andTechnology from July2012to November2016were retrospectively studied.The informed consents of allpatients were obtained and the local ethical committee approval had been received.According to whetherRRYGB was carried out or not,these patients were divided into the RRYGB group and the laparoscopicRoux-en-Y gastric bypass(LRYGB)group.Three patients were included into the RRYGB group,of whom1was male and2were females with an average age of(37±7)years old.Six patients were included intothe LRYGB group,of whom3were males and3were females with an average age of(31±7)years old.Operation time,intraoperative blood loss,postoperative ventilation time,postoperative hospital stay;andbody weight,body mass index(BMI),fasting plasma glucose(FPG),low density lipoprotein(LDL),high density lipoprotein(HDL),triglyceride(TG)and total cholesterol(TC)before and1month after operationwere compared between the two groups.Comparisons of these data between the two groups were conductedusing t test orχ2test.Results All the patients received bariatric surgery successfully.Intraoperative bloodloss of the RRYGB group was(46±7)ml,which was significantly lower than(82±6)ml of the LRYGB group(t=–8.03,P<0.05).One month after operation,BMI of the RRYGB and LRYGB groups were(34±5)and(35±4)kg/m2respectively,which were significantly lower than(39±7)and(40±5)kg/m2before operation(t=5.33,7.33,P<0.05);and there is no statistical difference in BMI reduction between the two groups.Conclusions RRYGB is a therapeutic method with a good short-term effect on obesity,but its safety andeffectiveness remain to be further investigated because the number of patients was too small and the fellowuptime was not long enough in this research.