中间入路腹腔镜胃袖状切除术治疗病态肥胖症73例疗效分析

Clinical outcome of media approach laparoscopic sleeve gastrectomy in the treatment of morbid obesity:An analysis of 73 cases

目的探讨中间入路腹腔镜胃袖状切除术(MALSG)治疗病态肥胖症及其相关合并症的有效性与安全性。方法回顾性分析2021年10月至2022年7月首都医科大学附属北京友谊医院普通外科中心实施MALSG的73例肥胖病人的临床资料。结果73例手术均在腹腔镜条件下顺利完成,无中转开放手术病例。手术时间为(95.8±14.4)(75~140)min,术前麻醉时间为(39.6±12.5)(18~70)min,术中失血量为(15.3±8.6)(5~50)m L,术后住院时间为(3.9±1.0)(3~9)d,每台手术所需钉仓数目为(5.2±0.4)(4~6)枚。术后近期并发症10例(13.7%),其中Ⅰ级8例,Ⅱ级2例。术后3个月总体重减轻百分比(%TWL)为(18.0±4.7)%。完成术后3个月随访的病人中,2型糖尿病、高血压病、高脂血症及高尿酸血症的缓解率分别为58.3%、43.5%、33.3%及18.5%。结论中间入路的腹腔镜胃袖状切除术治疗病态肥胖症及其相关合并症安全且有效,由于其更易实现胃底切除的同质化操作,可为减重医师提供新的手术入路选择。

Objective To investigate the effectiveness and safety of media approach laparoscopic sleeve gastrectomy(MALSG)for the treatment of morbid obesity and its associated comorbidities.Methods The clinical data of 73 obese patients who underwent MALSG at Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,from October 2021 to July 2022 were retrospectively analyzed.Results All 73 surgeries were successfully completed under laparoscopic conditions,with no cases of intermediate open abdomen.The operative time was 95.8±14.4 min(75-140 min),the preoperative anesthesia time was 39.6±12.5 min(18-70 min),the intraoperative blood loss was 15.3±8.6 mL(5-50 mL),the postoperative hospital stay was 3.9±1.0 day(3-9 day),and the number of stapler cartridges needed for each operation was 5.2±0.4(4-6).There were 10 cases(13.7%)with early postoperative complications,including 8 cases of grade I and 2 cases of grade II.The%TWL at 3 months postoperatively was(18.0+4.7)%.The remission rates of type 2 diabetes mellitus,hypertension,hyperlipidemia and hyperuricemia were 58.3%,43.5%,33.3%and 18.5%,respectively,in patients who completed the 3-month postoperative follow-up.ConclusionnMedia approach laparoscopic sleeve gastrectomy is safe and effective for the treatment of morbid obesity and related metabolic disorders,which may offer bariatric surgeons a new surgical option due to its greater ease of homogenous operation of gastric fundus excision.