单孔腹腔镜胃袖状切除术265例临床分析

A retrospective analysis of 265 cases of single incision laparoscopic sleeve gastrectomy

目的分析单孔腹腔镜胃袖状切除术(SPSG)在单中心临床应用的初步经验与结果,探讨SPSG在高BMI病人中应用的安全性和有效性。方法回顾性分析2023年2月至2024年6月复旦大学附属华东医院行SPSG的265例病人的临床资料。所有纳入病人分为BMI≥50组(21例)、40≤BMI<50组(63例)和BMI<40组(181例),比较三组病人手术时间、住院时间、并发症发生率、减重效果及代谢合并症缓解率等临床资料。结果三组病人均顺利完成SPSG,无中转开腹。BMI≥50组手术时间为(118.48±33.25)min,长于40≤BMI<50组[(86.24±22.35)min]和BMI<40组[(70.22±16.86)min];BMI≥50组住院时间为(9.67±4.23)d,明显长于40≤BMI<50组[(6.05±2.85)d]和BMI<40组[(5.25±1.93)d],差异有统计学意义(P<0.05)。BMI≥50组追加操作孔率、放置引流率、手术失血量、术前住院时间、术后住院时间均高于40≤BMI<50组和BMI<40组,差异有统计学意义(P<0.05)。BMI≥50组术后并发症发生率、多余体重减少百分比、总体重减少百分比、代谢合并症缓解率与40≤BMI<50组和BMI<40组相比差异无统计学意义(P>0.05)。结论高BMI并不是SPSG的绝对禁忌证,充分的术前评估、准备及恰当的术中处置对于SPSG的规范开展具有重要意义。

Objective To explore the safety and efficacy of SPSG in patients with high BMI by analyzing the preliminary experience and results of single port laparoscopic sleeve gastrectomy(SPSG)in single center.Methods Clinical data of 265 patients with SPSG at Huadong Hospital Affiliated to Fudan University from February 2023 to June 2024 was retrospectively analyzed.They were divided into BMI≥50 group(n=21),50>BMI≥40 BMI group(n=63)and BMI<40 group(n=181).Clinical data such as operation time,length of stay,incidence of complications,weight loss effect and remission rate of comorbidities were compared and analyzed between the three groups.Results All patients in the three groups received the operation successfully and were discharged without conversion to laparotomy.The mean operation time in BMI≥50 group was(118.48±33.25)min,which was longer than(86.24±22.35)min in 40≤BMI<50 group and(70.22±16.86)min in BMI<40 group(P<0.05).The hospitalization time of BMI≥50 group was(9.67±4.23)d,which was significantly longer than that of the other two groups(6.05±2.85)d and(5.25±1.93)d,respectively,and the difference was statistically significant(P<0.05).In BMI≥50 group,the additional operation hole rate,placement drainage rate,surgical blood loss,preoperative hospital stay and postoperative hospital stay were higher than those in 40≤BMI<50 group and BMI<40 group,with statistical significance(P<0.05).There were no significant differences in postoperative complication rate,percentage of excess weight loss,percentage of total weight loss and remission rate of metabolic comorbidities in BMI≥50 group compared with 40≤BMI<50 group and BMI<40 group(P>0.05).Conclusion High BMI is not an absolute contraindication of SPSG.Adequate preoperative evaluation,preparation and appropriate intraoperative treatment are of great significance for the successful completion of SPSG.