腹腔镜袖状胃切除术中缝合加固切缘的必要性探讨:历史性队列研究

Staple-line reinforcement or not during laparoscopic sleeve gastrectomy:a historical cohort study

目的通过评估腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)中缝合加固切缘的可能效益和安全性,以探讨LSG中缝合加固切缘的必要性。方法回顾性收集华中科技大学同济医学院附属协和医院胃肠外科2022年6月至2023年8月期间由同一组医师连续收治并实施LSG的肥胖患者,根据术中切缘是否行缝合加固分为加固组和未加固组,比较2组患者的术前一般资料、术中情况、术后恢复情况等资料。结果共有87例行LSG患者,均顺利完成,无一例中转开腹手术。其中加固组34例,未加固组53例,2组患者的年龄、性别、身高、体质量、体质量指数等比较差异无统计学意义(P>0.05)。2组患者术后均未发生胃漏、出血、消化道狭窄等并发症,也无围术期死亡患者,术后30 d内无再手术病例,并且2组患者在术后住院时间及总住院时间比较差异均无统计学意义(P>0.05),而发现未加固组的手术时间短于加固组(P<0.05),而且手术费用及总住院费用也少于加固组(P<0.05)。结论从本组病例资料分析结果看,在实施LSG中行缝合加固切缘并未减少术后胃漏、出血等并发症的发生,然而却延长了手术时间及增加了费用,因此行LSG中缝合加固切缘的必要性值得进一步探讨。

Objective To explore the necessity of staple-line reinforcement(SLR)during laparoscopic sleeve gastrectomy(LSG)through evaluating its potential benefit and safety.Methods A historical cohort study was conducted in the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology.The consecutive patients underwent LSG for morbid obesity by the same operative team from June 2022 to August 2023 were included,which were assigned into SLR group and un-SLR group according to the SLR or not.Both groups were assessed in terms of the operating time,postoperative hospital stay,total hospital stay,surgical costs,and complications.ResultsA total of 87 patients underwent the LSG from June 2022 to August 2023,all of whom were successfully completed without any conversion to open surgery.Among them,there were 34 cases in the SLR group and 53 cases in the un-SLR group.There were no statistical differences in the age,gender,body mass index,and so on between the two groups(P>0.05).There were no postoperative complications such as gastric leakage,bleeding,or gastrointestinal stenosis,and no perioperative death,as wellas no case of reoperation within 30 d after surgery in all patients of the two groups.And there were no statistical differences in the postoperative hospital stay and total hospital stay between the two groups(P>0.05).However,it was found that the operative time was shorter(P<0.05),the surgical costs and total hospital stay costs were also less(P<0.05)in the un-SLR group as compared with the SLR group.Conclusions Based on the analysis of cases data in this study,there is no added benefit in terms of reducing staple-line leak,bleeding,etc.in adopting SLR during LSG,and the operating time is prolonged and the cost is increased.So the necessity of the SLR or not during LSG needs to be further researched.