达芬奇机器人手术系统袖状胃切除术治疗肥胖症及其合并症的临床疗效
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摘要
目的探讨达芬奇机器人手术系统袖状胃切除术治疗肥胖症及其相关并发症的临床疗效。方法回顾性分析2016-01/2017-06月在作者医院行达芬奇机器人手术系统袖状胃切除术的20例肥胖症患者资料。观察手术及术后恢复情况、减重效果及肥胖相关并发症改善情况。采用微信、电话、门诊及住院等方式进行随访,随访时间为术后3个月、6个月、1年。结果 20例患者均成功施行达芬奇机器人手术,无中转开腹。手术时间为(2.30±0.47)h,术中出血量为(64.25±19.14)ml。下床活动时间为(2.10±0.64)d,术后胃肠功能恢复时间为(1.95±0.69)d,腹腔引流管拔除时间为(4.20±0.77)d,术后住院时间为(8.15±1.09)d。全组患者术后无胃瘘、胃腔出血及胃腔狭窄等严重并发症发生和围手术期死亡。20例患者均获得术后随访。与术前相比,术后12个月患者体质量、体质量指数(body mass index,BMI)、腰围、臀围、腰臀比均显著下降(P均<0.05),减重效果显著。术后1年,20例肥胖患者相关合并症脂肪肝、高血压、高脂血症、2型糖尿病、阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)、多囊卵巢综合征、骨关节炎均得到不同程度的缓解和改善。结论达芬奇机器人手术系统袖状胃切除术治疗肥胖症及其相关并发症安全可行,近期临床效果显著。
Objective To investigate the safety and clinical efficacy of da Vinci robotic surgical system sleeve gastrectomy in treatment of obesity and its related co-morbidities. Methods Clinical data of 20 obese patients who underwent da Vinci robotic surgical system sleeve gastrectomy in authors' hospital from January 2016 to June 2017 were retrospectively analyzed. The operation and postoperative recovery, the effect of weight loss and co-morbidity improvement were observed. The patients were followed up by Wechat, telephone, outpatient clinic and hospitalization at 3 rd, 6 th,12 th month postoperatively. Results All patients underwent successful da Vinci robotic surgical system sleeve gastrectomy,without conversion to open surgery. Operation time,volume of intraoperative blood loss,time of out-of-bed activity,time of postoperative gastrointestinal function recovery, time of postoperative drainage tube removal and duration of hospital stay were(2. 30±0.47) h,(64. 25±19. 14) ml,(2.10±0. 64) days,(1. 95±0.69) days,(4. 20±0. 77) days,(8. 15±1.09) days, respectively. All patients wtihout serious complications, such as gastrostoma, gastric bleeding, gastral cavity stenosis and perioperative death. All patients were followed up. Compared with pre-operation, the average body weight,body mass index(BMI), waist circumference, hip circumference, waist-hip ratio at 12 th month postoperative decreased significantly(all P<0.05). The comorbidities were fatty liver, hypertension, hyperlipemia, type 2 diabetes mellitus,obstructive sleep apnea hypopnea syndrome(OSAHS),polycystic ovary syndrome and osteoarthritis, which were improved one year after operation. Conclusion da Vinci robotic surgical system sleeve gastrectomy is safe and effective in treatment of obesity and its co-morbidities, with a good short-term outcome.
Objective To investigate the safety and clinical efficacy of da Vinci robotic surgical system sleeve gastrectomy in treatment of obesity and its related co-morbidities. Methods Clinical data of 20 obese patients who underwent da Vinci robotic surgical system sleeve gastrectomy in authors' hospital from January 2016 to June 2017 were retrospectively analyzed. The operation and postoperative recovery, the effect of weight loss and co-morbidity improvement were observed. The patients were followed up by Wechat, telephone, outpatient clinic and hospitalization at 3 rd, 6 th,12 th month postoperatively. Results All patients underwent successful da Vinci robotic surgical system sleeve gastrectomy,without conversion to open surgery. Operation time,volume of intraoperative blood loss,time of out-of-bed activity,time of postoperative gastrointestinal function recovery, time of postoperative drainage tube removal and duration of hospital stay were(2. 30±0.47) h,(64. 25±19. 14) ml,(2.10±0. 64) days,(1. 95±0.69) days,(4. 20±0. 77) days,(8. 15±1.09) days, respectively. All patients wtihout serious complications, such as gastrostoma, gastric bleeding, gastral cavity stenosis and perioperative death. All patients were followed up. Compared with pre-operation, the average body weight,body mass index(BMI), waist circumference, hip circumference, waist-hip ratio at 12 th month postoperative decreased significantly(all P<0.05). The comorbidities were fatty liver, hypertension, hyperlipemia, type 2 diabetes mellitus,obstructive sleep apnea hypopnea syndrome(OSAHS),polycystic ovary syndrome and osteoarthritis, which were improved one year after operation. Conclusion da Vinci robotic surgical system sleeve gastrectomy is safe and effective in treatment of obesity and its co-morbidities, with a good short-term outcome.
引文
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[2]中国医师协会外科医师分会肥胖和糖尿病外科医师委员会.中国肥胖和2型糖尿病外科治疗指南(2014)[J].中国实用外科杂志,2014,34(11):1005-1010
[3]刘洋,刘欢妹,魏丹,等.三孔法腹腔镜胃袖状切除术治疗肥胖症的临床疗效[J].中华消化外科杂志,2017,16(6):566-570
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[8]Hahl T,Peromaa-Haavisto P,Tarkiainen P,et al.Outcome of Laparoscopic Gastric Bypass(LRYGB)with a Program for Enhanced Recovery After Surgery(ERAS)[J].Obes Surg,2015,26(3):505-511
[9]余佩武,罗华星.达芬奇机器人手术系统在消化外科的应用与展望[J].中华消化外科杂志,2016,15(9):861-867
[10]余佩武,郝迎学.胃肠手术---机器人优于2D和3D腹腔镜[J].中华胃肠外科杂志,2015,18(8):767-768
[11]Rosenthal RJ,Diaz AA,Arvidsson D,et al.International Sleeve Gastrectomy Expert Panel Consensus Statement:best pratice guidelines based on experience of>12,000cases[J].Surg Obes Relat Dis,2012(1):8-19
[12]Sakran N,Goitein D,Raziel A,et al.Gastric leaks after sleeve gastrectomy:a multicencer experience with 2,834 patients[J].Surg Endosc,2013,27(1):240-245
[13]梁辉,管蔚,曹庆,等.腹腔镜胃袖状切除术的标准化操作流程探索[J].中华消化外科杂志,2015,14(7):534-538
[14]刘金钢.中国减重代谢外科的现状和变迁[J].中华胃肠外科杂志,2017,20(4):378-382
[15]Rubino F,Nathan DM,Eckel RH,et al.Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes:a Joint Statement by International Diabetes Organizations[J].Diabetes Care,2016,39(6):861-877
[16]Almogy G,Crookes PF,Anthone GJ.Longitudinal gastrectomy as a treatment for the high-risk super-obese patient[J].Obes Surg,2004,14(4):492-497
[17]Gagner M,Deitel M,Kalberer TL,et al.The second international consensus summit for sleeve gastrectomy,March 19-21,2009[J].Surg Obes Relat Dis,2009,5(4):476-485
[18]周庆,支永发,汪志强.3D腹腔镜胃袖状胃切除术治疗肥胖症合并2型糖尿病的临床疗效[J].中华消化外科杂志,2017,16(6):571-574
[19]Pekkarinen T,Mustonen H,Sane T,et al.Long-term effect of gastric bypass and sleeve gastrectomy on severe Obesity:do preoperative weight loss and binge eating behavior predict the outcome of bariatric surgery?[J].Obes Surg,2016,26(9):2161-2167
[20]Schauer PR,Bhatt DL,Kirwan JP,et al.Bariatric Surgery versus Intensive Medical Therapy for Diabetes-5-Year Outcomes[J].N Engl J Med,2017,376(7):641-651
[2]中国医师协会外科医师分会肥胖和糖尿病外科医师委员会.中国肥胖和2型糖尿病外科治疗指南(2014)[J].中国实用外科杂志,2014,34(11):1005-1010
[3]刘洋,刘欢妹,魏丹,等.三孔法腹腔镜胃袖状切除术治疗肥胖症的临床疗效[J].中华消化外科杂志,2017,16(6):566-570
[4]Mannaerts GH,van Mil SR,Stepaniak PS,et al.Results of Implementing an Enhanced Recovery After Bariatric Surgery(ER-ABS)Protocol[J].Obes Surg,2016,26(2):303-312
[5]Rickey J,Gersin K,Yang W,et al.Early discharge in the bariatric population does not increase post-discharge resource utilization[J].Surg Endosc,2017,31(2):618-624
[6]Awad S,Carter S,Purkayastha S,et al.Enhanced recovery after bariatric surgery(ERABS):clinical outcomes from a tertiary referral bariatric centre[J].Obes Surg,2014,24(5):753-758
[7]Abraham A,Ikramuddin S,Jahansouz C,et al.Trends in Bariatric Surgery:Procedure Selection,Revisional Surgeries,and Readmissions[J].Obes Surg,2016,26(7):1371-1377
[8]Hahl T,Peromaa-Haavisto P,Tarkiainen P,et al.Outcome of Laparoscopic Gastric Bypass(LRYGB)with a Program for Enhanced Recovery After Surgery(ERAS)[J].Obes Surg,2015,26(3):505-511
[9]余佩武,罗华星.达芬奇机器人手术系统在消化外科的应用与展望[J].中华消化外科杂志,2016,15(9):861-867
[10]余佩武,郝迎学.胃肠手术---机器人优于2D和3D腹腔镜[J].中华胃肠外科杂志,2015,18(8):767-768
[11]Rosenthal RJ,Diaz AA,Arvidsson D,et al.International Sleeve Gastrectomy Expert Panel Consensus Statement:best pratice guidelines based on experience of>12,000cases[J].Surg Obes Relat Dis,2012(1):8-19
[12]Sakran N,Goitein D,Raziel A,et al.Gastric leaks after sleeve gastrectomy:a multicencer experience with 2,834 patients[J].Surg Endosc,2013,27(1):240-245
[13]梁辉,管蔚,曹庆,等.腹腔镜胃袖状切除术的标准化操作流程探索[J].中华消化外科杂志,2015,14(7):534-538
[14]刘金钢.中国减重代谢外科的现状和变迁[J].中华胃肠外科杂志,2017,20(4):378-382
[15]Rubino F,Nathan DM,Eckel RH,et al.Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes:a Joint Statement by International Diabetes Organizations[J].Diabetes Care,2016,39(6):861-877
[16]Almogy G,Crookes PF,Anthone GJ.Longitudinal gastrectomy as a treatment for the high-risk super-obese patient[J].Obes Surg,2004,14(4):492-497
[17]Gagner M,Deitel M,Kalberer TL,et al.The second international consensus summit for sleeve gastrectomy,March 19-21,2009[J].Surg Obes Relat Dis,2009,5(4):476-485
[18]周庆,支永发,汪志强.3D腹腔镜胃袖状胃切除术治疗肥胖症合并2型糖尿病的临床疗效[J].中华消化外科杂志,2017,16(6):571-574
[19]Pekkarinen T,Mustonen H,Sane T,et al.Long-term effect of gastric bypass and sleeve gastrectomy on severe Obesity:do preoperative weight loss and binge eating behavior predict the outcome of bariatric surgery?[J].Obes Surg,2016,26(9):2161-2167
[20]Schauer PR,Bhatt DL,Kirwan JP,et al.Bariatric Surgery versus Intensive Medical Therapy for Diabetes-5-Year Outcomes[J].N Engl J Med,2017,376(7):641-651