腹腔镜胃袖状切除术中保留胃窦部及His角完整性对术后恶心呕吐的影响

Preserving the integrity of gastric antrum and His angle during laparoscopic sleeve gastrectomy reduced postoperative nausea and vomiting

目的探讨腹腔镜胃袖状切除术中保留胃窦部及His角完整性对术后恶心呕吐(postoperative nausea and vomiting,PONV)及止吐药物使用的影响。方法回顾性分析首都医科大学附属北京潞河医院内分泌与代谢病科2022年1月至2023年7月行腹腔镜胃袖状切除手术的肥胖症病人80例,根据术中是否保留胃窦部及His角周围组织完整性分为保留胃窦部及His角完整性组(A组,36例)和常规手术组(B组,44例)。对比分析两组术后24 h内恶心呕吐、止吐药物使用、术后肠道功能恢复情况及术后出院时间的差异性。结果A组与B组病人PONV发生率比较[术后12 h:27.8%(10/36)比59.1%(26/44),术后24 h:33.3%(12/36)比65.9%(29/44)],差异均有统计学意义(均P<0.05);A组、B组术后24 h止吐药物使用次数分别为(0.7±1.2)次、(1.4±1.1)次,差异有统计学意义(P<0.05);A组比B组术后首次肛门排气时间更早(P<0.05);两组病人术后首次饮水和住院时间差异均无统计学意义(均P>0.05)。结论保留胃窦部及His角完整性有利于降低胃袖状切除术PONV的发生率,减少术后止吐药物的使用及促进术后胃肠道功能的恢复。

Objective To explore the effect of preserving the integrity of gastric antrum and His angle during laparoscopic sleeve gastrectomy(LSG)on postoperative nausea and vomiting(PONV)and dosing of antiemetics.Methods The relevant clinical data were retrospectively reviewed for 80 obese patients undergoing LSG.They were assigned into two groups of A and B according to whether or not integrity of gastric antrum and His angle was preserved intraoperatively.Group A had intact gastric antrum and His angle while group B underwent routine operation.The inter-group differences of PONV,dosing of antiemetics,postoperative intestinal function recovery and postoperative discharge time were compared.Results The incidence of PONV between group A and group B was compared[12 h after surgery:27.8%(10/36)vs.59.1%(26/44),24 h after surgery:33.3%(12/36)vs.65.9%(29/44)],and the differences were statistically significant(all P<0.05).The use times of antiemetics 24 h after surgery were(0.7±1.2)times in group A and(1.4±1.1)times in group B,respectively,and the difference was statistically significant(P<0.05).The first time of anal exhaust in group A was earlier(P<0.05).There was no significant difference in the first postoperative water intake and hospital stay between the two groups(all P>0.05).Conclusion Preserving the integrity of gastric antrum and His angle is conducive to lowering the incidence of PONV post-LSG,reducing postoperative dosing of antiemetics and promoting the recovery of gastrointestinal function.