三孔腹腔镜袖状胃切除术联合单吻合口十二指肠-空肠旁路术操作技巧及疗效  

Operative techniqueandefficacyyofthree-incision laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy

作　　者：田晨旭 桑庆 杜德晓 许光中 王亮 李哲宏 陈炜坚 张能维 Tian Chenxu;Sang Qing;Du Dexiao;Xu Guangzhong;Wang Liang;Li Zhehong;Chen Wejian;Zhang Nengwei(Center for Obesity and Metabolic Diseases,Capital Medical University Afiliated Beijing Shijitan Hospital,Beijing100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院肥胖与代谢病中心,北京100038

出　　处：《中华普通外科杂志》2024年第6期465-469,共5页Chinese Journal of General Surgery

摘　　要：目的介绍在采取三孔腹腔镜袖状胃切除术联合单吻合口十二指肠-空肠旁路术治疗肥胖合并2型糖尿病患者中手工双层缝合的手术细节,以及该技术的可行性和安全性.方法回顾性分析2019年1月至2022年7月于北京世纪坛医院采取三孔腹腔镜袖状胃切除术联合单吻合口十二指肠-空肠旁路术治疗52例肥胖合并2型糖尿病患者(BMI 27.59~43.71 kg/m^(2))的临床资料.结果52例患者手术均获成功.中位手术时间为120(90,120)min,中位术中出血量为20.0(10.0,27.5)ml.术后1个月内未观察到患者发生瘘或严重手术并发症.与术前相比,患者体重降低[(93.22±15.21)kg比(69.97±11.06)kg,t=21.707,P<0.01]、BMI降低[(33.11±4.09)kg/m^(2)比(24.86±2.95)kg/m^(2),t=23.224,P<0.01]、空腹血糖水平降低[9.52(7.57,12.96)mmol/L比5.47(4.66,6.39)mmol/L,Z=6.11,P<0.01],差异均有统计学意义.各种肥胖合并症的缓解率明显提高.结论在三切口腹腔镜的条件下,纯手工十二指肠和空肠双层缝合方法对于肥胖合并2型糖尿病患者是安全、可行、有效的.Objective To present the surgical details of manual double-layer suturing in patients with obesity combined type 2 diabetes mellitus by three-incision laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy.Methods Clinical data and follow-up information of 52 obesity combined type 2 diabetes mellitus patients(BMI 27.59-43.71 kg/m^(2))who underwent three-incision laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy from Jan 2019 to Jul 2022 at Beijing Shijitan hospital were retrospectively analyzed.Results The procedure was successful in all patients.The median operative time was 120(90,120)min,and the median intraoperative bleeding was 20.0(10.0,27.5)ml.No fistula or serious surgical complications were observed in the patients at 1 month postoperatively.Compared with the preoperative period,the patient's weight decreased[(93.22±15.21)kg vs.(69.97±11.06)kg,t=21.707,P<0.01],BMI decreased[(33.11±4.09)kg/m^(2) vs.(24.86±2.95)kg/m^(2),t=23.224,P<0.01],and the patient's fasting glucose level decreased[9.52(7.57,12.96)mmol/L vs.5.47(4.66,6.39)mmol/L,Z=6.11,P<0.01].The remission rate of various obesity comorbidities was greatly improved.Conclusion Under the condition of three-incision laparoscopy,the pure manual duodenal and jejunal double-layer suture method is safe,feasible,and effective for patients with obesity combined with type 2 diabetes mellitus.

关 键 词：肥胖症 缝合技术 胃切除术 糖尿病 2型 

分 类 号：R656.61[医药卫生—外科学]