200例腹腔镜袖状胃切除术后并发症处理和分析

Cause analysis and treatment of the complications after laparoscopic sleeve gastrectomy in 200 cases

目的探讨腹腔镜袖状胃切除术(LSG)后并发症的发生原因和处理方法。方法回顾性分析2007年4月至2015年5月在暨南大学附属第一医院接受LSG治疗的200例肥胖症患者的临床资料。所有患者均签署由医院伦理委员会批准的患者知情同意书,符合医学伦理学规定。其中男40例,女160例;平均年龄(30±10)岁;平均体质指数(37±6)kg/m^2。记录每例患者的手术完成情况,并于术后1、3、6、12个月及之后每年对患者进行1次随访调查,随访内容包括体质量、血糖、血液生化指标、代谢和营养指标的改善情况及肥胖相关合并症和手术并发症的缓解情况等。随访时间截至2017年5月。结果200例患者均成功完成LSG治疗,无中转开腹。术后发生胃切缘出血1例、胃食管返流病1例、胃漏1例、反复剧烈呕吐1例、食管裂孔疝2例、减重失败1例,所有并发症均经保守或手术治疗后好转或痊愈。结论 LSG后出现的并发症多与术中操作不当有关,早期快速精确的诊断和术后积极正确的处理对于治疗并发症有着重要意义,预防LSG并发症永远是第一位。

Objective To investigate the causes and management of complications afterlaparoscopic sleeve gastrectomy(LSG).Methods Clinical data of200obese patients undergoing LSGin the First Affiliated Hospital of Jinan University between April2007and May2015were retrospectivelystudied.The informed consents of all patients were obtained and the local ethical committee approval hadbeen received.Among the200patients,40were males and160were females with an average age of(30±10)years old and an average body mass index of(37±6)kg/m2.The surgical situation was recorded for eachpatient,and they were followed-up at1,3,6and12month postoperatively and then yearly thereafter,upto May2017.The contents of follow-up included body weight,blood glucose,blood biochemical indexes,improvement of metabolic and nutritional indicators and remission of obesity-related complications andsurgical complications.Results All patients received LSG successfully without conversion to laparotomy.After operation,gastric tangential bleeding occurred in1case,gastroesophageal reflux disease in1case,gastric fistula in1case,recurrent severe vomiting in1case,hiatal hernia in2cases and weight loss failurein1case;however all these complications were improved or cured by conservative or operative treatments.Conclusions Most of the complications occurred after LSG are related to unsuitable procedure duringLSG,early and accurate diagnosis and postoperative correct management are meaningful for treating LSG complications,and the complication prevention always comes first.