两切口法腹腔镜袖状胃切除术治疗单纯性肥胖效果分析

Effect analysis of two-incision laparoscopic sleeve gastrectomy for the treatment of simple obesity

目的 总结两切口法腹腔镜袖状胃切除术治疗单纯性肥胖的临床经验及应用价值.方法 回顾性分析2016年1月-2017年2月南京医科大学第一附属医院收治的11例因单纯肥胖接受两切口法腹腔镜袖状胃切除术患者的临床资料.计量资料以均数±标准差((x)±s)表示.通过累积和法计算学习曲线,术后1、3、6、9、12个月时通过门诊复诊或电话随访,了解患者术后并发症、减重效果及对腹壁美容效果的满意程度.结果 所有患者均顺利完成两切口法腹腔镜袖状胃切除术,平均手术时间为(83.2±10.7) min,平均术中出血量为(15.3±8.2)ml,平均术后住院时间为(3.8±1.3)d.学习曲线分析发现,对于有经验的减重外科医师,经过5例两切口法腹腔镜袖状胃切除术的练习即可掌握.术后通过门诊及电话随访1～12个月,所有患者均未出现胃切缘漏及腹腔感染等并发症,未出现切口感染、液化、延迟愈合及脐疝形成.术后1、3、6、9、12个月,多余体重减少百分比分别为(26.3±3.2)％、(47.4±5.3)％、(65.7±7.3)％、(70.5±7.9)％及(80.2±10.7)％.所有患者对腹壁切口减少的美容效果均较满意.结论 两切口法腹腔镜袖状胃切除术具有安全、有效、操作简便及学习曲线短的优点.相较于传统五切口法袖状切除术,两切口法腹腔镜袖状胃切口术能显著减少腹壁切口,增加术后腹壁美容效果.

Objective To summarize the clinical experience and application value of two-incision laparoscopic sleeve gastrectomy for the treatment of simple obesity.Methods From January 2016 to February 2017,the clinical data and follow-up results of 11 patients with simple obesity who underwent twoincision laparoscopic sleeve gastrectomy in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.Data were expressed by mean standard deviation.The learning curve was analyzed based on the cumulative sum method.At the 1st,3rd,6th,9th and 12th months after surgery,the postoperative complications,weight loss and satisfaction of abdominal cosmetic effect were also collected and analyzed through the follow-up of outpatient service or telephone.Results All the patients were successfully completed the two-incision laparoscopic sleeve gastrectomy,with the mean operation time of (83.2 ± 10.7) minutes,mean intraoperative blood loss of (15.3 ± 8.2) ml and mean postoperative hospital stay of (3.8 ± 1.3) days.Learning curve analysis indicated that the expierenced bariatric surgeon could master the two-incision laparoscopic sleeve gastrectomy after five cases of practice.During the follow-up ranged from 1 to 12 months through outpatient and telephone,none of the patients was sufferred from the postoperative complications including leakage of the gastric sleeve,abdominal abscess,incision infection,incision liquefaction,delayed wound healing and umbilical hernia.The excess weight loss was (26.3 ± 3.2) ％,(47.4±5.3)％,(65.7±7.3)％,(70.5±7.9)％ and (80.2±10.7)％ at the 1st,3rd,6th,9th and 12th months follow-up after surgery.All the patients were satisfied with cosmetic outcomes of the reduced abdominal trocar incisions.Conclusions Two-incision laparoscopic sleeve gastrectomy is safe and effecive.Moreover,it is asscosicated with convinient operational management,short learning curve,and increased abdominal cosmetic effect compared with conventional five-incision laparoscopic sleeve gastrectomy.