日间腹腔镜胃袖状切除手术可行性及安全性研究

Preliminary study about feasibility and safety of ambulatory laparoscopic sleeve gastrectomy

目的探讨开展日间腹腔镜胃袖状切除术(LSG)的可行性及安全性。方法回顾性分析2018年8月至2019年8月上海交通大学医学院附属第九人民医院行LSG的45例BMI≤40的肥胖合并代谢综合征病人的临床资料。其中日间手术16例(日间LSG组),常规手术29例(常规LSG组)。对比分析两组病人手术时间、住院时间、住院费用、并发症发生率及术后多余体重减少百分比(%EWL)等临床数据。结果日间LSG占同期LSG病人的35.6%。两组病人均顺利完成手术并出院。日间LSG组总住院时间及术后住院时间均明显短于常规LSG组[(1.9±0.3)d vs.(4.5±2.4)d,P<0.01;(0.9±0.2)d vs.(1.5±0.7)d,P<0.05]、总住院费用明显低于常规LSG组[(41535.0±2312.9)元vs.(50476.1±5053.5)元,P<0.01];两组间术后并发症发生率、再入院率、术后第6和12个月%EWL差异无统计学意义(P>0.05)。结论通过严格选择适应证、积极术前准备,日间LSG能够安全有效地开展,可明显缩短住院时间,降低住院费用,且不增加并发症发生率。

Objective To investigate the feasibility and safety of ambulatory laparoscopic sleeve gastrectomy(LSG).Methods The clinical data of 45 patients(BMI≤40)with metabolic syndrome who received LSG in Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine from August 2018 to August 2019 were analyzed retrospectively.Among them,there were 16 cases of ambulatory surgery(ambulatory LSG group)and 29 cases of conventional surgery(conventional LSG group).The operation time,hospital length of stay,hospital cost,complication rate,excess weight loss percentage(%EWL)between two groups were compared.Results Ambulatory LSG accounted for 35.6%of all patients with BMI≤40 in the same period.Total length of stay and postoperative length of stay in ambulatory LSG group were significantly shorter than those in conventional LSG group[(1.9±0.3)d vs.(4.5±2.4)d,P<0.01;(0.9±0.2)d vs.(1.5±0.7)d,P<0.05],total hospital cost in ambulatory LSG group was significantly lower than that of the conventional LSG group[(41535.0±2312.9)yu an vs.(50476.1±5053.5)yuan,P<0.01].There was no significant difference in postoperative complication rate,readmission rate,%EWL at postoperative 6 and 12 months between the two groups.All patients were discharged without serious complications successfully.Conclusion Through strict selection of indications and careful preoperative preparation,ambulatory LSG can be safely and effectively carried out,which can shorten length of stay,reduce hospital cost without increasing incidence of complications.