胃前壁或后壁空肠吻合在腹腔镜Roux-en-Y胃旁路术治疗肥胖合并2型糖尿病中的对比研究

目的:分析胃前壁或后壁空肠吻合在腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)治疗肥胖合并2型糖尿病患者中的临床差异。方法:将2011年1月至2013年8月收治的80例18~65岁的LRYGB患者随机分为胃前壁组(40例)与胃后壁组(40例),其中女56例,男24例。均由同一术者施术。观察两组患者术中失血量、手术时间、术后排气时间、进食时间、住院时间及并发症发生情况。结果:术后随访3~52周,平均(28.0±7.4)周。无一例发生围手术期死亡。两组患者术中失血量、手术时间、术后排气时间、进食时间及住院时间差异无统计学意义(P>0.05)。两组术中均未发生吻合口漏,术后并发症发生率(肠梗阻、吻合口瘘、倾倒综合征、出血、肺栓塞)两组相比差异无统计学意义(P>0.05)。结论:LRYGB术中行胃空肠吻合时选择胃前、后壁对患者的影响差异无统计学意义,两种吻合方式均可用于腹腔镜Roux-en-Y胃旁路术。

Comparative study between anterior and posterior gastric wall during the gastrojejunal anastomosis in laparoscopic Roux-en- Y gastric bypass in the treatment of obese patients with type 2 diabetes mellitus

Objective：Laparoscopic Roux-en-Y gastric bypass （LRYGB） has become the most common surgical procedure in the treatment of obese patients with type 2 diabetes mellitus （T2DM）. However, during the gastrojejunal anastomosis whether the selec- tion of anterior or posterior wall of the stomach has different effect to patients remains unclear. The study compared the difference be- tween anterior and posterior wall of the stomach during the gastrojejunal anastomosis in the treatment of obese patients with T2DM by LRYGB. Methods：This prospective, randomized study enrolled 80 cases （56 females and 24 males） of 18-65 years old LRYGB patients who were divided into anterior wall of the stomach group （40 cases） and posterior wall of the stomach group （40 cases） according to the random method from Jan. 2011 to Aug. 2013. All procedures were implemented by the same surgeon. The patients＇intraoperative blood loss, operative time, postoperative exhaust time, eating time, length of hospital stay and incidence of complications in both groups were recorded. Results：The patients had a mean follow-up of （28 ± 7.4） weeks （ranged,3-52 weeks）, and there was no perioperative mortality of patients. The patients＇intraoperative blood loss, operative time, postoperative exhaust time, eating time and length of hospital stay in the two groups were not significantly different （P 〉 0.05）. There was no intraoperative anastomotic leakage in the two groups, and the postoperative complications （ intestinal obstruction, anastomotic fistula, dumping syndrome, bleeding, pulmonary embolism） had no significant difference yet （P 〉 0.05 ）. Conclusions： The selection of anterior or posterior wall of the stomach has no different effect to patients with LRYGB during the gastrojejunostomy. Therefore, both anterior and posterior wall of the gastrojejunal anastomosis can be used for LRYGB to treat obesity in patients with T2DM.