SIPS手术治疗重度肥胖症

目的:探讨SIPS(stomach intestinal pylorus sparing)治疗重度肥胖症的临床价值及手术方法。方法:26岁女性患者,因重度肥胖症(BMI=69.4 kg/m~2)接受SIPS减重手术。建立40~42 Fr袖状胃,在胃幽门下2~3 cm处横断十二指肠球部,近端断口与回肠在距回盲瓣约300cm处行端侧吻合,对袖状胃及吻合ロ测漏后,手术完成。结果:手术顺利,出血量较少,患者顺利出院,无明显的围手术期并发症,与入院时相比,术后3周体重减轻20 kg。结论:SIPS由于保留了胃幽门,避免了胃旁路术后常见的倾倒综合征;因为仅建立一个吻合口,可避免术后内疝的发生。应用SIPS治疗重度肥胖症效果确切、安全性高,推荐用于治疗BMI50 kg/m~2的重度肥胖或糖尿病病史较长(10年)的患者。

SIPS surgery in the treatment of super obesity

Objective:To investigate and report the feasibility and safety of stomach intestinal pylorus sparing ( SIPS) surgery in the treatment of super obesity. Methods:A 26-year old female underwent SIPS surgery due to super morbid obesity with a BMI of 69. 4 kg/m2 . After completion of sleeve gastrectomy calibrated by a 40-42 Fr bougie,bulb part of duodenum was transected at 2-3 cm distal to pylorus. An end-to-side anastomosis was established by proximal duodenal end and ileum at 300 cm to terminal ileum. Then gastric sleeve and the anastomosis were tested for potential leaks. Results:The surgery went smoothly with minor bleeding. The patient was discharged in time without any notable perioperative complications. The patient obtained 20 kg weight loss 3 weeks after surgery when comparing with the weight on the day of admission. Conclusions:Dumping syndrome which often occurs in Roux-en-Y gastric by-pass can be avoided by SIPS due to preservation of pylorus. In addition,internal hernia can also be prevented since only one intestinal anastomosis is established in SIPS surgery. SIPS surgery leads to a predicable postoperative outcome and a high safety profile in super obese patients,therefore,is suggested to recommend to super obese ( BMI>50 kg/m2 ) patients or obese patients with more than 10 years’ history of diabetes.