单切口经脐腹腔镜胃旁路术与腹腔镜5孔胃旁路术的比较研究

目的腹腔镜胃旁路手术Roux-en-Y已经成为减重手术的金标准,但常规手术常需要5～7个皮肤切口来放置trocar,因此,切口可能会产生不尽患者满意的结果。我们设计了一个治疗病态肥胖的新技术:单切口经脐胃旁路手术(singleincision transumbilical LRYGB,SITU-LRYGB)。本研究比较腹腔镜5孔胃旁路手术(5-port LRYGB)和SITU-LRYGB手术结果与患者满意度。方法 50例重度肥胖(男14例,女36例)分别接受5-port LRYGB(25例)或SITU-LRYGB(25例)。在肚脐上方以Omega形状切口6 cm,在直接可视下、将3个trocar分置于三角形的三角位置入。术中我们使用新设计的肝脏牵引方法———肝悬吊带。结果术后2组皆未出现接口泄漏或出血并发症。SITU组手术时间较5-port LRYGB组长(99.8±11.1)min vs(67.6±20.5)min,t=6.906,P=0.000]。对术后切口,SITU组有更高的满意度(4.5±0.6)分vs(4.0±0.7)分,t=2.712,P=0.009]。结论腹腔镜胃旁路手术可以成功地以单切口经脐方式来施行,除了手术时间短与术后恢复良好之外,几乎无瘢痕是手术最让病人满意的地方。

Single-incision Trans-umbilical vs. Five-port Laparoscopic Roux-en-Y Gastric Bypass

Objective Conventional laparoscopic Roux-en-Y gastric bypass（LRYGB） is a golden standard for bariatric surgery,but the procedure requires five to seven incisions for placement of multiple trocars and thus may produce less than ideal cosmetic results.We have developed a new approach,single-incision transumbilical LRYGB（SITU-LRYGB）,to treat morbid obesity.This is a study comparing the surgical results and patient satisfaction of five-port LRYGB and SITU-LRYGB. Methods Fifty morbidly obese patients（14 males,36 females） underwent either Roux-en-Y gastric bypass with five-port LRYGB or the SITU-LRYGB approach.During the operation,we used a novel intraoperative liver traction method with a ＂liver suspension tape＂ that we specifically designed for SITU-LRYGB. Results There was no operative complication in these two groups,neither leakage nor hemorrhage.SITU operative time was longer than that with five-port LRYGB （99.8±11.1）min vs.（67.6±20.5）min（t=6.906 P=0.000）].Patient satisfaction was greater with SITU than that with the five-port method 4.5±0.6 vs.4.0±0.7（t=2.712,P=0.009）].Conclusions Roux-en-Y gastric bypass can be successfully achieved via a single umbilical incision,a method that provides a short operative time and good recovery and eliminates abdominal scarring.Scarless result makes the high satisfaction.