腹腔镜单吻合口十二指肠转位术治疗重度肥胖症的临床疗效  

Clinical efficacy of laparoscopic stomach intestinal pylorus sparing surgery in the treatment of severe obesity

作　　者：王伦 李世星 于洋[1] 王金发[1] 赵玉会 白麟 陈蜀 姜涛[1] Wang Lun;Li Shixing;Yu Yang;Wang Jinfa;Zhao Yuhui;Bai Lin;Chen Shu;Jiang Tao(Department of Bariatric and Metabolic Surgery,China⁃Japan Union Hospital,Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院减重与代谢外科,长春130033

出　　处：《中华消化外科杂志》2019年第12期1171-1177,共7页Chinese Journal of Digestive Surgery

基　　金：吉林省财政厅科研基金资助项目(SCZSY201707)。

摘　　要：目的探讨腹腔镜单吻合口十二指肠转位术(SIPS)治疗重度肥胖症的临床疗效。方法采用回顾性描述性研究方法。收集2018年10至11月吉林大学中日联谊医院收治的5例重度肥胖症患者的临床资料;男1例,女4例;平均年龄为33岁,年龄范围为18~55岁。5例患者均行腹腔镜SIPS。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊、电话及微信等方式进行随访,了解患者术后3个月内的一般情况,包括体质量、体质量指数、腰围、血压、多余体质量减少率、空腹血糖、糖化血红蛋白、血脂及尿酸。随访时间截至2019年2月。正态分布的计量资料以x􀭰±s表示,采用Hotelling T2检验,偏态分布的计量资料以M(范围)表示。结果(1)手术情况:5例重度肥胖症患者均顺利施行腹腔镜SIPS,手术视野清晰,未见明显出血,无中转开腹及围术期死亡,手术时间为240 min(165~345 min)。(2)术后情况:5例重度肥胖症患者术后首次下床活动时间为2 d(2~3 d),术后首次肛门排气时间为3 d(2~3 d),术后首次进食清流食时间为3 d(3~4 d)。5例重度肥胖症患者于术后第3天行上消化道造影检查示吻合口通畅,无吻合口漏,无狭窄、梗阻,嘱咐患者进食全流食后均未诉明显不适且引流管未见异物引出,于术后第4天拔除腹腔引流管。5例重度肥胖症患者出院时间为术后6 d(6~7 d)。(3)随访情况:5例重度肥胖症患者均获得术后随访,随访时间为术后3个月。随访期间,1例患者大便次数明显增多,每日排便次数为5~8次,尤其在进食油腻食物后排便感明显,经个案管理师饮食指导,患者减少油性食物的摄入后排便明显好转。5例重度肥胖症患者中,2例术后3个月门诊行肝胆彩超检查示胆汁淤积,其原因可能为患者术后体质量大幅下降、胆汁酸与胆固醇浓度比例失调、肠道菌群改变、迷走神经损伤、胆囊黏蛋白显著增加和未按医嘱口服熊去氧胆Objective To investigate the clinical efficacy of laparoscopic stomach intestinal pylorus sparing surgery(SIPS)in the treatment of severe obesity.Methods The retrospective and descriptive study was conducted.The clinical data of 5 patients with severe obesity who were admitted to the China⁃Japan Union Hospital Affiliated to Jilin University from October to November 2018 were collected.There was 1 male and 4 females,aged from 18 to 55 years,with an average age of 33 years.All the 5 patients underwent laparoscopic SIPS.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow⁃up.Follow⁃up was performed by outpatient examination,telephone interview and Wechat up to February 2019,including general condition,changes in body weight,body mass index,waistline,blood pressure,percentage of excess weight loss,fasting plasma glucose,glycosylated hemoglobin,blood lipid,and uric acid at 3 months after surgery.Measurement data with normal distribution were represented as Mean±SD,and they were tested with Hotelling T2 test.Measurement data with skewed distribution were represented as M(range).Results(1)Surgical situations:5 patients underwent successfully laparoscopic SIPS under clear surgical field,without obvious bleeding,conversion to open surgery or perioperative death.The operation time was 240 minutes(range,165-345 minutes).(2)Postoperative situations:the time to initial out⁃of⁃bed activity,time to first and flatus,and time to initial drinking and liquid intake were 2 days(range,2-3 days),3 days(range,2-3 days),and 3 days(range,3-4 days),respectively.On the third day after surgery,all the 5 patients were confirmed anastomotic patency,without gastric leakage,stenosis,or obstruction by upper gastrointestinal contrast.The abdominal drainage⁃tube was removed on the fourth day after feeding without obvious discomfort and foreign substances extraction from the drainage⁃tube.The duration of postoperative hospital stay was 6 days(range,6-7 days).(3)Follow⁃up:5 patients with severe obesity

关 键 词：肥胖症 2型糖尿病 单吻合口十二指肠转位术 胆胰转流术 腹腔镜检查 

分 类 号：R47[医药卫生—护理学]