胃小弯空肠侧侧吻合在腹腔镜胃旁路术中的应用  

The report of the application of side to side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic gastric bypass

作　　者：闫文貌[1] 白日星[1] 徐天磊 李有国[1] 钟志强[1] 刑颖[1] 闫鸣[1] 袁辉生[1] 宋茂民[1] 

机构地区：[1]首都医科大学附属天坛医院普外科,北京100050

出　　处：《中华腔镜外科杂志（电子版）》2015年第3期14-18,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨胃小弯空肠侧侧吻合方法在腹腔镜下胃旁路手术治疗2型糖尿病中应用的安全性和可行性。方法回顾性分析2012年4月至2014年10月在首都医科大学附属北京天坛医院普外科腹腔镜下胃旁路术治疗的86例2型糖尿病患者的临床资料,胃空肠吻合均采用胃小弯空肠侧侧吻合方法。结果所有患者均顺利完成全腹腔镜下胃旁路术,无中转开腹。手术时间1.5~5.8 h,平均（2.7±0.9）h;出血量10~200 ml,平均（63.6±35.3）ml;术后住院时间4~29 d,平均（6.3±2.8）d。围术期未出现胃空肠吻合口出血、瘘及狭窄。1例小肠Y吻合口出血行二次手术。术后随访3~30个月,有7例发生不全肠梗阻症状,1例因胃空肠吻合口狭窄行二次手术,2例出现体重指数低于18.5 kg/m2,2例患者出现缺铁性贫血。术后3、6、12、24个月体重指数较术前明显下降,差异有统计学意义（P〈0.05）。术后3、6、12、24个月在停服降血糖药情况下,糖化血红蛋白〈7.0%的患者分别占73.3%、81.2%、71.0%、78.9%。结论胃小弯空肠侧侧吻合方法应用于全腹腔镜下胃旁路术治疗2型糖尿病安全、操作简单、易于掌握。Objective To evaluate the safety and feasibility of the application of side to side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic gastric bypass. Methods The files of 80 patients with type 2 diabetes mellitus undergoing totally laparoscopic gastric bypass without intracorporal hand-sewn sutures from Apr. 2012 to Oct. 2014 were analyzed retrospectively in general surgery,Beijing Tiantan Hospital affiliated to Capital Medical University. It was adopted by the side to side anastomosis of the lesser curvature of stomach and jejunum in all cases. To evaluate the security of the nastomosis technology by observing complications of the perioperative and long-term; to evaluate the efficacy of it by observing the situation of diabetes remission、weight losing and improvement of diabetic complications and comorbidities. Results All cases were successfully completed in totally laparoscopic gastric bypass with the side to side anastomosis of the lesser curvature of stomach and jejunum, without conversion to laparotomy. The operative time 1. 5-5. 8（ 2. 7 ± 0. 9） hour,blood loss 10-200（ 63. 6 ± 35. 3） ml,and postoperative hospital stay 4 ~ 29（ 6. 3 ± 2. 8） day. There is no case with gastrojejunostomy anastomotic bleeding,fistula,obstruction,deep vein thrombosis,incision infections,intra-abdominal hernia,death and other complications after operations. There is one case who underwent secondary surgery because of bleeding of side to side anastomosis between intestinal. Followed up for 3 to 30 months. There are seven patients with incomplete intestinal obstruction, one patient who underwent secondary surgery because of the gastrojejunostomy anastomotic stricture,two patients with BMI 18. 5 kg / m2 and two patients with iron deficiency anemia. BMI 3,6,12,24 months post-operation significantly reduced compared with preoperative,and there is a statistically significant（ P 0. 05）. The percentage of patients Hb A1 c 7. 0% without antidiabetic drugs respectively 73. 3%,81. 2%,71. 0%,78. 9%

关 键 词：胃旁路术 2型糖尿病 胃空肠吻合 腹腔镜 

分 类 号：R656[医药卫生—外科学]