腹腔镜袖状胃切除术中夹闭切缘血管减少胃切缘出血的回顾性研究

目的探讨腹腔镜袖状胃切除术(LSG)胃切缘出血的相关因素与处理措施。 方法回顾性分析2017年1月至2018年12月82例行LSG术患者资料，采用SSPS20.0软件统计分析，统计术中胃切缘出血与切缘血管处理及术中血压的关系，采用χ²检验，P<0.05差异具有统计学意义。 结果患者BMI≥40、高血压、有阻塞性睡眠呼吸暂停(OSA)与胃切缘出血率的关系密切(P<0.01)；切割胃壁后胃切缘出血60例(73.2%)，胃切缘无出血22例(26.8%)。术中胃壁切割闭合前，进行切缘血管预夹闭28例，切割后发生出血10例；未进行切缘血管预夹闭54例，切割后发生出血50例(χ²＝30.39，P＝0.000)。切割胃壁过程中26例患者血压大于130 mmHg，其中14例切缘出血需要处理；56例患者血压小于等于130 mmHg，其中15例切缘出血需要处理(χ²＝5.69，P＝0.017)。 结论LSG中预夹闭切缘血管可有效减少胃切缘出血，控制术中血压130 mmHg以下可减少胃切缘出血，且胃切缘出血后通过夹闭切缘血管和降低血压至130 mmHg以下可以有效控制出血。

A retrospective study of staple line bleeding in laparoscopic sleeve gastrectomy

Objective To explore the related factors and preventive treatments of staple line bleeding in laparoscopic sleeve gastrectomy(LSG). Methods From Jan. 2017 to Dec. 2018, 82 cases received LSG, of whom clinical data were analyzed retrospectively. Statistical analysis were performed by using SSPS20.0 software. Staple line bleeding, periphery vessels clamping treatment and intraoperative blood pressure level were examined by using χ^2 test. Results BMI≥40, hypertension and obstructive sleep apnea(OSA) were closely correlated with the rate of gastric staple line bleeding.(P<0.01). There were 60 cases(73.2%) of intraoperative bleeding of the gastric staple line and 22 cases(26.8%) of less bleeding. In the 28 cases of ligating peripheral vessels with Ligasure prior to stapling, 10 cases occurred obvious staple line bleeding. While 50 cases occurred obvious staple line bleeding in the 54 cases without preventive clamping(χ^2=30.39, P=0.000). There were 26 patients with blood pressure ≥130 mmHg and 56 patients with blood pressure ≤130 mmHg during stapling of the greater curvature. Among the 26 patients with blood pressure ≥130 mmHg and the 56 patients blood pressure ≤130 mmHg during stapling, 14 and 15 cases required intervention respectively(χ^2=5.69, P=0.017). Conclusion Preventive clamping of periphery vessels and decreasing blood pressure could prevent staple line bleeding effectively in LSG, and clamping periphery vessels with Ligasure and decreasing blood pressure below 130 mmHg could reduce the staple line bleeding.