右侧微创三孔法腹腔镜袖状胃切除术治疗肥胖症的应用价值

Application value of right minimal invasive three-port technique of laparoscopic sleeve gastrectomy for the treatment of obesity

目的探讨右侧微创三孔法腹腔镜袖状胃切除术(RMIT‑LSG)治疗肥胖症的应用价值。方法采用回顾性描述性研究方法。收集2021年1—10月浙江大学医学院附属邵逸夫医院收治的66例肥胖症行RMIT‑LSG患者的临床资料;男15例,女51例;年龄为28.5(16.0~54.0)岁,体质量指数(BMI)为(36.9±4.3)kg/m^(2);其中20例患者合并2型糖尿病。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。通过门诊或微信方式进行随访,了解患者术后恢复情况,术后6个月随访患者体质量变化情况、BMI和并发症情况。随访时间截至2021年12月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。结果(1)手术情况。66例患者均完成RMIT‑LSG,无中转开腹或更改手术方式;手术时间为(132±22)min,术中出血量为(14±8)mL。(2)术后情况。66例患者术后首次下床活动时间为(15±6)h,术后首次肛门排气时间为(1.80±0.60)d,术后首次饮水时间为(1.00±0.20)d,术后首次进食流质食物时间为(2.00±0.20)d,术后住院时间为(3.40±0.60)d。66例患者中,1例术后第1天出现腹腔出血,予二次手术止血,恢复顺利;其余均恢复良好,无胃瘫、胃瘘、腹腔感染等并发症。(3)随访情况。66例患者术后均获得随访,随访时间为6(1~11)个月。术后1个月随访时,66例患者常规行术后瘢痕摄像,瘢痕隐蔽具有较好美容效果。27例患者随访时间6个月,体质量降低(42±7)kg,减重比例达34.8%±2.9%,BMI降低(14.2±1.9)kg/m^(2);66例患者随访期间未发现营养不良。结论RMIT‑LSG治疗肥胖症安全、有效,切口美容效果较好。

Objective To investigate the application value of right minimal invasive threeport technique of laparoscopic sleeve gastrectomy(RMIT-LSG)for the treatment of obesity.Methods The retrospective and descriptive study was conducted.The clinical data of 66 obesity patients who underwent RMIT‐LSG in the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from January to October 2021 were collected.There were 15 males and 51 females,aged 28.5(range,16.0‒54.0)years.The body mass index(BMI)of the 66 patients was(36.9±4.3)kg/m^(2).There were 20 of the 66 patients combined with type 2 diabetes.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow‐up.Follow‐up was conducted using outpatient examination or the WeChat to detect postoperative recovery of patients including body mass changing,BMI and complications 6 months after operation.The follow‐up was up to December 2021.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Surgical situations.All the 66 patients underwent RMIT‐LSG successfully,without conversion to laparotomy or changing surgical method.The operation time and the volume of intraoperative blood loss of the 66 patients were(132±22)minutes and(14±8)mL,respectively.(2)Postoperative situations.The time to postoperative initial out‐of‐bed activities,time to postoperative first flatus,time to postoperative initial water intake,time to postoperative initial liquid food intake and duration of postoperative hospital stay of the 66 patients were(15±6)hours,(1.80±0.60)days,(1.00±0.20)days,(2.00±0.20)days and(3.40±0.60)days,respectively.Of the 66 patients,one case underwent postoperative abdominal hemorrhage at postoperative day 1 and received a second surgery for hemostasis.The patient with postoperative abdominal hemorrhage and other 65 patients recovered well without gastroparesis,gastric fistula,abdominal infection and other complication.(3)Follow‐up.All the 66 patients were followed up for 6(range,1‒11)months.All the 66 patients completed the postoperative scar photography at postoperative 1 month,and results of scar photography showed concealed scar with good cosmetic effects.Twenty‐seven of the 66 patients were followed up for 6 months after operation,with the weight loss,percentage of weight loss and decrease of BMI were(42±7)kg,34.8%±2.9%,(14.2±1.9)kg/m^(2),respectively.None of the 66 patient had innutrition during the follow‐up.Conclusion The RMIT‐LSG is safe and feasible for the treatment of obesity,with a good cosmetic effect of the wound.