腹腔镜胃折叠术联合十二指肠空肠Omega转位术在修正可调节胃绑带术中的应用价值  

Application value of laparoscopic gastric plication combined with duodeno-jejunal omega switch in modified adjustable gastric banding

作　　者：周程[1] 龚昭[1] 王威[1] 夏辉[1] 夏振雄[1] Karcz Wojciech Konrad Zhou Cheng;Gong Zhao;Wang Wei;Xia Hui;Xia Zhenxiong;Karcz Wojciech Konrad(Department of Hepatobililary Surgery, Wuhan No.1 Hospital, Wuhan 430022, China;Clinic of General, Visceral, Transplantaion and Vascular Surgery, Hospital of Ludwig Maximilian University, Munich 80803, Germany)

机构地区：[1]武汉市第一医院肝胆外科,430022 [2]慕尼黑大学医学院普通外科,德国慕尼黑80803

出　　处：《中华消化外科杂志》2019年第9期879-883,共5页Chinese Journal of Digestive Surgery

基　　金：湖北陈孝平科技发展基金(CXPJJH11800001-2018203).

摘　　要：目的探讨腹腔镜胃折叠术(LGP)联合十二指肠空肠Omega转位术(DJOS)在修正可调节胃绑带术中的应用价值。方法采用回顾性描述性研究方法。收集2016年12月至2018年12月德国慕尼黑大学医学院收治的1例行可调节胃绑带术失效患者的临床资料;患者女,年龄为46岁。患者完善术前相关检查后,一期行LGP,二期行DJOS。观察指标:(1)手术及术后情况。(2)随访情况。采用门诊和电话方式进行随访,了解患者术后体质量指数(BMI)、胰岛素治疗及远期并发症情况。随访时间截至2018年12月。计数资料采用绝对数表示。结果(1)手术及术后情况:患者一期顺利施行LGP,二期顺利施行DJOS。LGP手术时间、消化道重建时间、术中出血量、术后肛门首次排气时间、引流管拔除时间、术后恢复正常饮食时间、术后住院时间分别为96min、58min、210mL、32h、48h、42d、3d。DJOS上述指标分别为148min、117min、260mL、47h、72h、21d、7d。患者LGP和DJOS术中、术后均未发生并发症。(2)随访情况:患者获得术后随访,随访时间为LGP术后24个月。LGP术后6个月患者BMI降至45.3kg/m^2,DJOS术后18个月,BMI降至37.2kg/m^2。患者术后未行胰岛素治疗。术后未发生营养不良、倾倒综合征及胆汁反流等并发症。结论LGP联合DJOS可完善BMI>50kg/m2肥胖症患者的治疗手段,且为特殊患者如胃绑带术后患者提供更安全的手术选择。Objective To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding. Methods The retrospective and descriptive study was conducted. The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected. LGP and DJOS were performed in two-stages after completion of preoperative examinations. Observation indicators:(1) surgical and postoperative situations;(2) follow-up. Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI), insulin therapy, and long-term complications until December 2018. Count data were represented as absolute numbers. Results (1) Surgical and postoperative situations: the patient underwent LGP in the first stage and DJOS in the second stage successfully. For the LGP, the operation time, time of intestinal reconstruction, volume of intraoperative blood loss, time to first flatus, time to drainage tube removal, time to resume to normal diet, and duration of postoperative hospital stay were 96 minutes, 58 minutes, 210 mL, 32 hours, 48 hours, 42 days, and 3 days, respectively. For the DJOS, the above indicators were 148 minutes, 117 minutes, 260 mL, 47 hours, 72 hours, 21 days, and 7 days, respectively. There was no complication occurred in either LGP or DJOS.(2) Follow-up: the patient was followed up for 24 months after LGP. The BMI of this patient decreased to 45.3 kg/m^2 at 6 months after LGP, and decreased to 37.2 kg/m^2 at 18 months after DJOS. Insulin therapy was discontinued. There was no long-term complication such as malnutrition, dumping syndrome, or biliary reflux. Conclusion LGP combined with DJOS can enrich treatment methods of obese patient with BMI >50 kg/m^2, which offers a safer surgical procedure option for patients after gastric binding.

关 键 词：肥胖症 袖状胃切除术 胃折叠术 胆胰分流术 可调节胃绑带术 胃旁路术 Omega吻合 减重代谢外科 

分 类 号：R656.6[医药卫生—外科学]