切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 493 -496. doi: 10.3877/cma.j.issn.1674-3946.2021.05.008

论著

袖状胃切除+单吻合口十二指肠回肠旁路术中幽门下处理策略探讨
曹李1, 陈鹏1, 董光龙1,()   
  1. 1. 100853 北京,解放军总医院第一医学中心普通外科
  • 收稿日期:2020-11-09 出版日期:2021-10-26
  • 通信作者: 董光龙

Discussion on the treatment strategy of subpyloric in Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S)

Li Cao1, Peng Chen1, Guanglong Dong1,()   

  1. 1. Department of General Surgery, First Medical Center, General Hospital of PLA, Beijing 100853, China
  • Received:2020-11-09 Published:2021-10-26
  • Corresponding author: Guanglong Dong
  • Supported by:
    National Natural Science Foundation of China(81773247)
引用本文:

曹李, 陈鹏, 董光龙. 袖状胃切除+单吻合口十二指肠回肠旁路术中幽门下处理策略探讨[J]. 中华普外科手术学杂志(电子版), 2021, 15(05): 493-496.

Li Cao, Peng Chen, Guanglong Dong. Discussion on the treatment strategy of subpyloric in Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S)[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(05): 493-496.

目的

探讨袖状胃切除+单吻合口十二指肠回肠旁路术(SADI-S)中幽门下处理策略。

方法

回顾性分析2016年1月至2018年1月20例行3D腹腔镜下SADI-S患者病历及录像资料。

结果

本组20例患者均在3D腹腔镜下完成SADI-S,未出现中转开腹患者。手术时间为(110.4±12.8) min,范围为95~210 min;术中出血量为(32.3±4.7) ml,范围为20~100 ml;术后住院时间为(8.1±1.6) d,范围为5~14 d。术后1例患者出现间断性呕吐泡沫状物质,1例患者术后出现剑突下持续性疼痛,经对症、保守治疗后好转。其余患者未出现吻合口漏、十二指肠残端漏、腹腔出血、肠梗阻及Trocar孔疝等并发症。

结论

SADI-S术中采用隧道式游离幽门下区域,可避免对十二指肠周边血运影响,是一种简便、安全的处理方式。

Objective

To discussion on the treatment strategy of subpyloric in Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S).

Methods

Medical records and video material of 20 patients who received 3D laparoscopic SADI-S at our Center during the period from January 2016 to January 2018 were included in a retrospective analysis.

Results

SADI-S was conducted in all the 20 patients under 3D laparoscopy, without conversion to open surgery. The surgical duration was 95~210 min (mean, 110.4±12.8 min), the intraoperative bleeding volume was 20~100 ml (mean, 32.3±4.7 ml), the postoperative hospital stay was 5~14 d (mean, 8.1±1.6 d). After surgery, 1 patient vomited foam-like substance intermittently; 1 patient experienced persistent pain below the xiphoid process, both improved after symptomatic and conservative treatment. Other patients showed no symptoms of anastomotic leakage, duodenal stump leakage, intraabdominal hemorrhage, ileus, trocar hernia and other complications.

Conclusions

Tunnel-type dissociation of the infrapyloric area in SADI-S could avoid affecting blood supply around duodenum. It is therefore a simple and safe treatment.

图4 将回肠与十二指肠断端近端行连续手工端侧吻合
[1]
王勇,王存川,朱晒红,等. 中国肥胖及2型糖尿病外科治疗指南(2019版)[J]. 中国实用外科杂志201939(4):301-306.
[2]
宋志高,戴晓江,张红兵,等. 超级肥胖患者腹腔镜袖状胃切除术的疗效分析与经验分享[J/CD]. 中华腔镜外科杂志(电子版)201710(1):38-42.
[3]
Bashah M, Aleter A, Baazaoui J, et al. Single Anastomosis Duodeno\ileostomy (SADI-S) Versus One Anastomosis Gastric Bypass (OAGB-MGB) as Revisional Procedures for Patients with Weight Recidivism After Sleeve Gastrectomy: a Comparative Analysis of Efficacy and Outcomes[J]. Obesity Surg202030(12):4715-4723.
[4]
张鹏,余波,王廷峰,等. SIPS手术治疗重度肥胖症[J]. 腹腔镜外科杂志201722(1):7-11.
[5]
朱利勇,嵇光年,朱晒红,等. 从术式变迁看减重代谢外科发展趋势[J]. 中国实用外科杂志201939(4):316-321.
[6]
Sanchez-Pernaute A, Rubio Herrera MA, Perez-Aguirre E, et al. Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy:Proposed technique[J]. Obes Surg200717(12):1614-1618.
[7]
Shoar S, Poliakin L, Rubenstein R, et al. Single Anastomosis Duodeno-Ileal Switch (SADIS):A Systematic Review of Efficacy and Safety[J]. Obes Surg201828(1):104-113.
[8]
Surve A, Zaveri H, Cottam D. A safer and simpler technique of duodenal dissection and transection of the duodenal bulb for duodenal switch[J]. Surg Obes Relat Dis201612(4):923-924.
[9]
朱江帆. 十二指肠-小肠单吻合口手术的现状与展望[J]. 中华消化外科杂志201918(9):830-833.
[10]
Cottam S, Peter Ng, Sharp L, et al. Single-anastomosis duodenal ileostomy with sleeve is a safe and effective option for patients in an ambulatory surgical center[J]. Surg Obes Relat Dis201915(11):1990-1993.
[11]
Balibrea JM, Vilallonga R, Hidalgo M, et al. Mid-Term Results and Responsiveness Predictors After Two-Step Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy[J]. Obes Surg201727(5):1302-1308.
[12]
Sanchez-Pernaute A, Rubio MA, Cabrerizo L, et al. Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients[J]. Surg Obes Relat Dis201511(5):1092-1098.
[13]
Sanchez-Pernaute A, Rubio MA, Aguirre EP, et al. Single-anastomosis duodenoileal bypass with sleeve gastrectomy: metabolic improvement and weight loss in first 100 patients[J]. Surg Obes Relat Dis20139(5):731-735.
[14]
Surve A, Rao R, Cottam D, et al. Early Outcomes of Primary SADI-S: an Australian Experience[J]. Obes Surg202030(4):1429-1436.
[15]
Zaveri H, Surve A, Cottam D, et al. A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy[J]. Obes Surg201929(10):3165-3173.
[16]
姜涛. 腹腔镜胃袖状切除联合单吻合口十二指肠回肠旁路术治疗肥胖症及肥胖相关代谢病17例疗效分析[J]. 中国实用外科杂志202040(4):433-436.
[17]
Moon RC, Kirkpatrick V, Gaskins L, et al. Safety and effectiveness of single-versus double-anastomosis duodenal switch at a single institution[J]. Surg Obes Relat Dis201915(2):245-252.
[18]
Moon RC, Gaskins L, Teixeira AF, et al. Safety and Effectiveness of Single-Anastomosis Duodenal Switch Procedure: 2-Year Result from a Single US Institution[J]. Obes Surg201828(6):1571-1577.
[19]
Finno P, Osorio J, Garcia-Ruiz-de-Gordejuela A, et al. Single Versus Double-Anastomosis Duodenal Switch: Single-Site Comparative Cohort Study in 440 Consecutive Patients[J]. Obes Surg202030(9):3309-3316.
[20]
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. 关于单吻合口十二指肠转位手术(SADI-S/SIPS)的立场声明[J/CD]. 中华肥胖与代谢病电子杂志20195(4):183-186.
[21]
Wu A, Tian J, Cao L, et al. The study of single-anastomosis duodenoileal bypass with sleeve gastrectomy(SADI-S) as the revision surgery for laparoscopic adjustable gastric banding (LAGB)[J]. Surg Obes Relat Dis201814(11):1686-1690.
[22]
曹李,田靖波,董光龙. 袖状胃切除+单吻合口十二指肠回肠旁路术作为超级肥胖病人首选术式的合理性探讨[J]. 腹部外科201932(3):167-171,240.
[1] 代莉, 邓恢伟, 郭华静, 黄芙蓉. 术中持续输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响[J]. 中华普通外科学文献(电子版), 2023, 17(06): 408-412.
[2] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[3] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[4] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[5] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[6] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[7] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[8] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[9] 燕速, 霍博文, 徐惠宁. 4K荧光腹腔镜扩大右半结肠CME+D3根治术及No.206、No.204组淋巴结清扫术[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 14-14.
[10] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[11] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[12] 马涛, 叶春伟, 刘滔, 彭文希, 李志鹏. 腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 605-610.
[13] 刘成, 赖聪, 黄健, 王建辰, 罗茜芸, 许可慰. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 642-646.
[14] 叶晋生, 路夷平, 梁燕凯, 于淼, 冀祯, 贺志坚, 张洪海, 王洁. 腹腔镜下应用生物补片修补直肠术后盆底缺损的疗效[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 688-691.
[15] 夏松, 姚嗣会, 汪勇刚. 经腹腹膜前与疝环充填式疝修补术治疗腹股沟疝的对照研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 702-705.
阅读次数
全文


摘要