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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 56 -60. doi: 10.3877/cma.j.issn.1674-3946.2018.01.018

所属专题： 文献；

论著

腹腔镜袖状胃切除＋单吻合口十二指肠回肠旁路术(SADI－S)作为腹腔镜可调节胃束带术(LAGB)修正手术的短期疗效及安全性分析
吴安健1, 曹李1, 刘林1, 刘兢文1, 田靖波1, 金露佳1, 吴喜燕2, 刘志刚3, 董光龙1,†()   
  1. 1. 100853　北京解放军总医院普通外科
    2. 556000　凯里黔东南红州儿童医院
    3. 137099　吉林省白城市医院普通外科
  • 收稿日期:2017-11-25 出版日期:2018-02-26
  • 通信作者: 董光龙

Single-anastomosis duodenoileal bypass with sleeve gastrectomy(SADI-S)as the revisional surgery of laparoscopic adjustable gastric banding (LAGB): Short-term efficacy and safety

Anjian Wu1, Li Cao1, Lin Liu1, Jingwen Liu1, Jingbo Tian1, Lujia Jin1, Xiyan Wu2, Zhigang Liu3, Guanglong Dong1,†()   

  1. 1. Department of General Surgery, General Hospital of PLA, Beijing 100853, China
    2. Qiandongnan Hongzhou children’s Hospital, Kaili556000, China
    3. Department of general surgery, Baicheng Hospital, Baicheng 137099, China
  • Received:2017-11-25 Published:2018-02-26
  • Corresponding author: Guanglong Dong
  • About author:
    Corresponding author: Dong Guanglong, Email:
  • Supported by:
    The fund for capital clinic-oriented research and outcome application(grant number : Z151100004015209)
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引用本文：

吴安健, 曹李, 刘林, 刘兢文, 田靖波, 金露佳, 吴喜燕, 刘志刚, 董光龙. 腹腔镜袖状胃切除＋单吻合口十二指肠回肠旁路术(SADI－S)作为腹腔镜可调节胃束带术(LAGB)修正手术的短期疗效及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2018, 12(01): 56-60.

Anjian Wu, Li Cao, Lin Liu, Jingwen Liu, Jingbo Tian, Lujia Jin, Xiyan Wu, Zhigang Liu, Guanglong Dong. Single-anastomosis duodenoileal bypass with sleeve gastrectomy(SADI-S)as the revisional surgery of laparoscopic adjustable gastric banding (LAGB): Short-term efficacy and safety[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(01): 56-60.

目的

探讨腹腔镜袖状胃切除＋单吻合口十二指肠回肠旁路术(SADI－S)作为腹腔镜可调节胃束带术(LAGB)的修正手术2年的疗效及安全性。

方法

2013年11月至2015年11月接收LAGB术后复胖患者共22例，对其实施修正手术SADI－S，并统计分析其术前及术后24个月临床资料。

结果

SADI－S手术时间(105.0±12.2) min，手术出血量(27.3±5.8) ml；术后第1、3、6、12、18、24个月多余体质量减少率(%EWL)依次为(20.55±9.10) %、(40.1±6.02) %、(63.52±10.43) %、(70.72±8.54) %、(78.34±9.25) %、(81.57±11.12) %；本研究糖尿病缓解以术后2年为截点评判，17例T2DM患者达到完全缓解(17/18)，1例达到部分缓解(1/18)；SADI－S术后Trocar孔疝1例，再次手术还纳，其他患者术中无中转开腹，术后无梗阻、切缘及吻合口漏的发生，术后常规长期补充复合维生素及微量元素，未见维生素及微量元素缺乏。

结论

SADI－S作为LAGB术后复胖的修正手术短期内安全有效。其长期疗效及安全性仍需多中心的、大样本量、长期的随机对照研究。

关键词: 糖尿病，2型, 肥胖, 腹腔镜检查, 胃切除术, 治疗结果
Objective

To explore the efficacy and safety of single-anastomosis duodenoileal bypass with sleeve gastrectomy(SADI-S)as the revisional surgery of laparoscopic adjustable gastric banding (LAGB)according to the two-year follow-up results.

Methods

From November 2013 to November 2015, a total of 22 weight-regain patients that underwent previous LAGB, were given SADI-S as the revisional surgery at PLA General Hospital. Preoperative clinical characteristics as well as the data at the intervals of 1, 3, 6, 12, 18 and 24months after operation were collected and analyzed.

Results

The operation time of SADI-S was (105±12.2) min, and the intraoperative blood loss was (27.3±5.8) ml. The excess weight loss rate (%EWL) was (20.55±9.10) %, (40.1±6.02) %, (63.52±10.43)%, (70.72±8.54) %, (78.34±9.25) %, and (81.57±11.12)% at 1, 3, 6, 12, 18, 24months after the operation, respectively. The two-year complete remission rate of T2DM was 17/18, and the corresponding partial remission rate was 1/18 after operation. One case experienced trocar hernia and was repaired. There was no conversion to laparotomy. Vitamins and trace elements were administrated for these patients a long time after operation, and no patients experienced the deficiency of vitamin and trace element.

Conclusion

SADI-S is safe and effective as a revisional surgery for patients whose weight regain after LAGB. However, multicenter randomized controlled studies with large sample sizes are needed to explore the long-term efficacy and safety of SADI-S.

Key words: Diabetes Mellitus, Type 2, Obesity, Laparoscopy, Gastrectomy, Treatment Outcome
图2 距幽门约5 cm处开始以超声刀弓内离断胃网膜血管直至贲门左侧His角，分离胃后粘连
图4 以气囊胃管及标记为指引，进行切割闭合胃壁至His角
图6 距离幽门2 cm离断十二指肠
图8 置放引流管引流吻合口、切缘及胃底
图9 袖状胃切除＋单吻合口十二指肠回肠旁路术(SADI－S)示意图
图10 22例LAGB术后患者因复胖接受SADI－S修正术后%EWL随时间变化趋势图
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