单孔和小三孔腹腔镜袖状胃切除术治疗肥胖症的临床疗效

Clinical efficacy of single-port and mini-three-port laparoscopic sleeve gastrectomy for obesity

目的探讨单孔和小三孔腹腔镜袖状胃切除术(LSG)治疗肥胖症的临床疗效。方法采用倾向评分匹配及回顾性队列研究方法。收集中国肥胖代谢外科数据库2016年7月至2023年12月暨南大学附属第一医院收治的364例肥胖症患者的临床资料;男79例, 女285例;年龄为(31±9)岁。364例患者中, 67例行单孔LSG, 设为单孔组, 297例行小三孔LSG, 设为小三孔组。倾向评分匹配选用1∶1最近邻匹配法, 卡钳值设定为0.1。正态分布的计量资料以x±s表示, 组间比较采用t检验。偏态分布的计量资料以M(Q?, Q?)表示, 组间比较采用秩和检验。计数资料以绝对数表示, 组间比较采用χ^(2)检验或Fisher确切概率法。结果 (1)倾向评分匹配情况及匹配后两组患者一般资料比较。364例患者中, 126例配对成功, 其中单孔组和小三孔组各63例。倾向评分匹配后, 消除性别、体质量、体质量指数(BMI)、腰围、腰臀比因素混杂偏倚, 具有可比性。(2)术中和术后情况。两组患者均顺利完成LSG, 倾向评分匹配后单孔组63例患者手术时间为101(90, 120)min, 术中出血量为10(10, 10)mL, 术后止痛药使用次数为1.0(1.0, 2.5)次, 术后止吐药使用次数为3.0(1.0, 5.0)次, 术后住院时间为4(3, 5)d, 总住院时间为7(5, 8)d, 手术费用为4.1(3.5, 4.3)万元, 总住院费用为(6.4±0.8)万元;小三孔组63例患者手术时间为100(90, 120)min, 术中出血量为10(10, 15)mL, 术后止痛药使用次数为2.0(1.0, 4.0)次, 术后止吐药使用次数为4.0(3.0, 5.0)次, 术后住院时间为3(3, 4)d, 总住院时间为5(5, 6)d, 手术费用为3.2(2.8, 4.2)万元, 总住院费用为(5.8±0.8)万元;两组患者术后止吐药使用次数、术后住院时间、总住院时间、总住院费用比较, 差异均有统计学意义(Z=-2.39、-3.93、-3.03, t=4.04, P<0.05), 手术时间、术中出血量、术后止痛药使用次数、手术费用比较, 差异均无统计学意义(Z=-0.49, -1.00, -1.23, -1.47, P>0.05)。(3)随访情况。364例患者中, 195例完成术后1个月随访, 其中单孔组和小三孔组分别为25例和170例, 无患者发生胃漏、感染、切口疝等并发症。两组患者手术切口均恢复良好。倾向评分匹配后, 单孔组24例患者BMI变化(ΔBMI)、总体质量减轻百分比(%TWL)、多余体质量减少百分比(%EWL)分别为(3.7±1.4)kg/m^(2)、11.0%±3.0%、52.6%±30.0%;小三孔组40例患者上述指标分别为(4.1±1.3)kg/m^(2)、11.1%±2.8%、41.8%±19.1%。术后12个月, 单孔组和小三孔组完成随访患者例数分别为21例和131例, 倾向评分匹配后, 单孔组20例患者ΔBMI、%TWL、%EWL分别为(8.7±4.1)kg/m^(2)、26.2%±9.8%、130.0%± 45.1%;小三孔组36例患者上述指标分别为(9.8±4.0)kg/m^(2)、27.2%±8.7%、107.1%±40.7%。结论单孔和小三孔LSG用于治疗肥胖症均可取得满意的短期效果。

Objective To investigate the clinical efficacy of single-port and mini-three-port laparoscopic sleeve gastrectomy(MTP-SG)for obesity.Methods The propensity score matching and retrospective cohort study was conducted.The clinical data of 364 obesity patients in the Chinese Obesity and Metabolic Surgery Database who were admitted to The First Affiliated Hospital of Jinan University from July 2016 to December 2023 were collected.There were 79 males and 285 females,aged(31±9)years.Of 364 patients,67 cases undergoing single-port laparoscopic sleeve gastrectomy(SP-SG)were divided into the SP group,and 297 cases undergoing MTP-SG were divided into the MTP group.Propensity score matching was done by the 1:1 nearest neighbor matching method.The clamp value was set as 0.1.Measurement data with normal distribution were expressed as Mean+D,and t test was used for comparison between groups.Measurement data with skewed distribution were expressed as M(Q,Q),and the rank sum test was used for comparison between groups.Count data were expressed as absolute numbers,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Results(1)Propensity score matching and comparison of general data of patients between the two groups after matching.Of 364 patients,126 cases were successfully matched,including 63 cases in the SP group and 63 cases in the MTP group.After propensity score matching,the confounding bias of gender,body mass,body mass index(BMI),waist circumference,waist hip ratio were eliminated between the two groups.(2)Intraoperative and post-operative conditions.Both groups of patients successfully completed laparoscopic sleeve gastrectomy.After propensity score matching,the operation time,volume of intraoperative blood loss,number of postoperative painkillers used,number of postoperative antiemetics used,duration of postoperative hospital stay,duration of total hospital stay,surgical cost,and total hospitalization cost of the 63 pati-ents in SP group were 101(90,120)minutes,10(10,10)mL,1.0(1.0,2.5)times,3.0(1.0,5.0)times,4(3,5)days,7(5,8)days,4.1(3.5,4.3)ten thousand yuan,and(6.4+0.8)ten thousand yuan,respectively.The above indicators of the 27 patients in MTP group were 100(90,120)minutes,10(10,15)mL,2.0(1.0,4.0)times,4.0(3.0,5.0)times,3(3,4)days,5(5,6)days,3.2(2.8,4.2)ten thousand yuan,and(5.8±0.8)ten thousand yuan,respectively.There were significant differences in number of postoperative antiemetics used,duration of postoperative hospital stay,duration of total hospital stay and total hospitalization cost between the two groups(Z=-2.39,-3.93,-3.03,t=4.04,P<0.05),and there was no significant difference in operation time,volume of intraoperative blood loss,number of post-operative painkillers used and surgical cost between the two groups(Z=-0.49,-1.00,-1.23,-1.47,P>0.05).(3)Follow-up.One hundred and ninety five of the 364 patients conducted postoperative 1 month follow-up,including 25 patients in the SP group and 170 patients in the MTP group,and no patient experienced complications such as gastric leakage,infection,or incisional hernia.Both groups of patients had good surgical incisions.After propensity score matching,the change in BMI(ABMI),percentage of total weight loss(%TWL),and percentage of excess weight loss(%EWL)of 24 patients in the SP group were(3.7±1.4)kg/m^(2),11.0%±3.0%,52.6%+30.0%,respectively.The above indicators of 40 patients in the MTP group were(4.1±1.3)kg/m^(2),11.1%±2.8%,41.8%±19.1%,respectively.Patients who conducted the postoperative 12 month follow-up were 21 and 131 in the SP group and the MTP group,respectively.After propensity score matching,the ABMI,%TWL and%EWL of 15 patients in the SP group were(8.7±4.1)kg/m^(2),26.2%±9.8%,130.0%±45.1%,respectively.The above indicators of 36 patients in the MTP group were(9.8±4.0)kg/m^(2),27.2%±8.7%,107.1%+40.7%,respectively.Conclusion Both SP-SG and MTP-SG can be used to treat obesity patients and achieve satisfactory short-term results.