经剖腹产瘢痕或比基尼线切口入路在腹腔镜袖状胃切除术中的应用价值

Application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy

目的探讨经剖腹产瘢痕或比基尼线切口入路在腹腔镜袖状胃切除术中的应用价值。方法采用回顾性队列研究方法。收集2018年3月至2019年4月暨南大学附属第一医院收治的162例合并代谢性疾病肥胖症患者的临床资料;男51例,女111例;年龄为(35±8)岁,年龄范围为12~47岁。162例患者中,72例采用经剖腹产瘢痕或比基尼线切口入路行腹腔镜袖状胃切除术,设为隐蔽性切口组;90例采用经传统切口入路行腹腔镜袖状胃切除术,设为传统切口组。观察指标:(1)手术情况。(2)术中情况。(3)术后情况。(4)随访情况。采用门诊、电话、微信方式进行随访,随访时间为术后1、3、6个月和1、2、5年。了解患者术后并发症情况。随访时间截至2019年5月。正态分布的计量资料以Mean±SD表示,组间比较采用t检验。计数资料以绝对数表示,采用χ2检验或Fisher确切概率法。等级资料采用Wilcoxon秩和检验。结果(1)手术情况:隐蔽性切口组和传统切口组患者均顺利完成腹腔镜袖状胃切除术,无中转开腹、再手术、围术期死亡。(2)术中情况:隐蔽性切口组患者手术时间、术中出血量、术中额外增加孔道例数分别为(102±17)min、(11±4)mL、6例;传统切口组患者上述指标分别为(105±19)min、(11±4)mL、21例。两组患者手术时间、术中出血量比较,差异均无统计学意义(t=-1.232,-0.676,P>0.05)。两组患者术中额外增加孔道例数比较,差异有统计学意义(χ2=6.280,P<0.05)。(3)术后情况:隐蔽性切口组患者切口瘢痕总体满意度(非常满意、满意、不满意、非常不满意),术后住院时间,住院总费用分别为非常满意56例、满意16例、无不满意和非常不满意,(4.9±0.9)d,(64408±5123)元;传统切口组上述指标分别为非常满意42例、满意48例、无不满意和非常不满意,(5.2±1.5)d,(64953±3477)元。两组患者切口瘢痕总体满意度比较,差异有统计学意义(Z=-4.012,P<0.05),两组患者术后住院时间、住院总费用比较,差异均无统计学意义(t=-1.788,-0.804,P>0.05)。隐蔽性切口组患者中19例发生胃食管反流,无术后感染、出血、吻合口漏发生;传统切口组患者中14例发生胃食管反流,无术后感染、出血、吻合口漏发生。两组患者上述指标比较,差异均无统计学意义(χ2=2.894,P>0.05)。(4)随访情况:162例患者中,失访32例(隐蔽性切口组10例、传统切口组22例),130例患者随访时间为1~14个月,中位随访时间为7个月。随访期间,1例传统切口组患者术后3个月因上消化道出血返院行对症支持治疗后痊愈,1例隐蔽性切口组患者术后1个月因功能性肠梗阻在当地医院行对症治疗后好转出院。其余患者无术后并发症再次入院治疗。结论经剖腹产瘢痕或比基尼线切口入路在腹腔镜袖状胃切除术中安全、可行,具有良好的美容效果。

Objective To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy. Methods The retrospective cohort study was conducted. The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected. There were 51 males and 111 females, aged (35±8)years, with a range from 12 to 47 years. Of 162 patients, 72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group. Observation indicators:(1) surgical situations;(2) intraoperative situations;(3) postoperative situations;(4) follow-up. Follow-up using outpatient examination, telephone interview, and WeChat was performed to detect the postoperative complications at 1, 3, 6 months and 1, 2, 5 years postoperatively up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and the t test was used for comparison between groups. Count data were represented as absolute numbers, and were analyzed by the chi-square test or fisher exact probability. Ordinal data were analyzed by the Wilcoxon rank sum test. Results (1) Surgical situations: patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy, without conversion to open surgery, reoperation, or perioperative death.(2) Intraoperative situations: the operation time and volume of intraoperative blood loss of the concealed incision group were (102±17)minutes and (11±4)mL, respectively, versus (105±19)minutes and (11±4)mL of the traditional incision group (t=-1.232,-0.676, P>0.05). There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group, respectively, with a significant difference between the two groups (χ2=6.280, P<0.05).(3) Postoperative situations: in the concealed incision group, 56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance. In the traditional incision group, 42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance. There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z=-4.012, P<0.05). Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9)days and (64 408±5 123)yuan, versus (5.2±1.5)days and (64 953±3 477)yuan of the traditional incision group (t=-1.788,-0.804, P>0.05). There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group, respectively, with no significant difference between the two groups (χ2=2.894, P>0.05). There was no postoperative complication such as infection, hemorrhage or anastomotic leakage in either group.(4) Follow-up: 32 of 162 patients were lost to follow-up, including 10 in the concealed incision group and 22 in the traditional incision group;other 130 patients were followed up for 1-14 months, with a median follow-up time of 7 months. During the follow-up, 1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding, and was cured after symptomatic supportive treatment. One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment. Other patients had no readmission due to postoperative complications. Conclusion Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible, with good cosmetic effects.