单吻合口十二指肠转位术治疗肥胖症的 临床结局及影响因素分析  

Clinical outcome and influencing factor analysis of one anastomosis duodenal switch for obesity

作　　者：王泽雨 王伦 赵玉会 刘洋[1] 张峥 胡力夫 姜涛[1] Wang Zeyu;Wang Lun;Zhao Yuhui;Liu Yang;Zhang Zheng;Hu Lifu;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》2022年第11期1446-1451,共6页Chinese Journal of Digestive Surgery

基　　金：吉林省卫生科研人才专项项目(2020SCZ04)。

摘　　要：目的探讨单吻合口十二指肠转位术(OADS)治疗肥胖症的临床结局及影响因素。方法采用回顾性队列研究方法。收集2018年10月至2021年6月吉林大学中日联谊医院收治的104例肥胖症行OADS患者的临床资料;男42例,女62例;年龄为33(18~66)岁。采用教科书式结局(TO)分析患者临床结局。观察指标:(1)患者治疗情况。(2)TO情况。(3)术后达到TO的影响因素分析。采用门诊或电话方式进行随访,了解患者术后并发症情况。随访时间截至2021年11月。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Wilcoxon秩和检验;计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验;多因素分析采用二元Logistic回归模型。结果(1)患者治疗情况。104例患者均顺利完成OADS,术中无中转开腹及死亡患者。104例患者手术时间为(187±39)min、术后住院时间为6(4~55)d、2例再次入院、术者行OADS经验为(53±30)例;其中行达芬奇机器人手术系统OADS 82例,行腹腔镜OADS 22例。104例患者并发症发生率为7.69%(8/104),Clavien⁃DindoⅡ级、Ⅲb级、Ⅳ级并发症分别为5、2、1例。(2)TO情况。104例患者中,62例达到TO,42例未达到TO。达到TO患者手术时间、腹腔引流管留置时间、术后住院时间、术者行OADS经验、达芬奇机器人手术系统OADS分别为(166±26)min、0(0~7)d、6(4~7)d、(62±28)例、54例;未达到TO患者上述指标分别为(218±34)min、3(0~11)d、8(5~55)d、(38±27)例、28例;两者上述指标比较,差异均有统计学意义(t=-8.81,Z=-3.63,-5.33,t=4.27,χ^(2)=6.27,P<0.05)。达到TO患者无并发症发生,未达到TO患者8例发生并发症,两者比较,差异有统计学意义(P<0.05)。(3)术后达到TO的影响因素分析:多因素分析结果显示术者行OADS经验是患者OADS达到TO的独立影响因素(优势比=1.04,95%可信区间为1.01~1.06,P<0.05)。结论肥胖症患者�Objective To investigate the clinical outcome and influencing factor of oneanastomosis duodenal switch(OADS)for obesity.Methods The retrospective cohort study was conducted.The clinical data of 104 obesity patients who underwent OADS in the China-Japan Union Hospital of Jilin University from October 2018 to June 2021 were collected.There were 42 males and 62 females,aged 33(range,18‒66)years.The clinical outcome of each patient was evaluated using Textbook Outcome(TO).Observation indicators:(1)treatment situations for patients;(2)TO situations;(3)analysis of factors affecting postoperative TO.Follow-up was conducted using outpatient examination or telephone interview to detect postoperative complication of patients up to November 2021.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted using the Wilcoxon rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using chi-square test.Multivariate analysis was conducted using the binary Logistic regression model.Results(1)Treatment situations for patients.All 104 patients underwent OADS without conversion to laparotomy or death of patient.The operation time and duration of postoperative hospital stay of the 104 patients were(187±39)minutes and 6(range,4‒55)days,respectively.Two of the 104 patients were readmitted.The experiences of surgeons on OADS was(53±30)cases.There were 82 patients underwent OADS using the Da Vinci robotic surgical system,while there were 22 patients underwent OADS using laparoscopic surgery system.The complication rate of 104 patients was 7.69%(8/104).Cases with stageⅡ,stageⅢb and stageⅣcomplications of the Clavien Dindo classification were 5,2 and 1,respectively.(2)TO situation.Of the 104 patients,62 cases achieved TO,while 42 cases did not achieve TO.The operation time,retentio

关 键 词：肥胖症 单吻合口十二指肠转位术 临床结局 教科书式结局 达芬奇机器人手术系统 

分 类 号：R656.61[医药卫生—外科学]