腹腔镜胃袖状切除术有必要做胃切缘加强吗?

Is staple line reinforcement necessary during laparoscopic sleeve gastrectomy?

腹腔镜胃袖状切除术是目前开展最为普遍的减重手术方式。胃漏和出血是胃袖状切除后最严重的并发症。胃袖状切除后切缘加强被认为是避免术后出血或胃漏的有效措施,然而亦有部分减重外科医师不做任何形式的胃切缘加强。腹腔镜胃袖状切除术后是否需要切缘加强,仍是有争议的问题。目前多数文献资料认为切缘加强有利于减少切缘出血,对胃漏并无预防作用。做切缘加强会增加手术时间及药品、器材消耗,降低性价比,同时影响手术周转。预防胃袖状切除术后胃漏或出血的可能途径包括游离中避免胃底损伤,使用高质量吻合器,胃底切割时保持组织平整,切割后仔细检查胃切缘及妥善处理切缘出血,以及术后恶心、呕吐的有效预防与治疗。

Laparoscopic sleeve gastrectomy is currently the most commonly adopted bariatric procedure. Gastric leak and bleeding are the most severe postoperative complications. Gastric staple line reinforcement has been considered as an effective remedy. However, some surgeons do not employ any reinforcement technique during sleeve gastrectomy. Suture or not suture remains a hot issue for debating. As compared with standard stapling, staple line reinforcement could reduce minor or major postoperative hemorrhage and yet had no obvious impact on staple line leak rate. The major disadvantages for staple line reinforcement are longer anesthesia time, more usage of narcotics, lower patient turnover and more operator stamina. Proper practices include avoidance of fundus damage, using high-quality stapler, uniform tissue flattening during stapling, meticulous inspection of staple line after stapling and effective interventions of postoperative nausea and vomiting.