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) ›› 2026, Vol. 20 ›› Issue (01) : 5 -8. doi: 10.3877/cma.j.issn.1674-3946.2026.01.002

专家论坛

腹腔镜胃袖状切除术:我们的做法与争议
朱江帆(), 卢列盛   
  1. 200072 上海,同济大学肥胖症研究所,同济大学附属第十人民医院代谢外科
  • 收稿日期:2024-11-26 出版日期:2026-02-26
  • 通信作者: 朱江帆

Laparoscopic sleeve gastrectomy: how we do it and technical controversies

Jiangfan Zhu(), Liesheng Lu   

  1. The institute of obesity, Tongji University School of Medicine, Shanghai 200072 China; Metabolic Surgery, the 10th Hospital, Tongji University School of Medicine, Shanghai 200072, China
  • Received:2024-11-26 Published:2026-02-26
  • Corresponding author: Jiangfan Zhu
引用本文:

朱江帆, 卢列盛. 腹腔镜胃袖状切除术:我们的做法与争议[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(01): 5-8.

Jiangfan Zhu, Liesheng Lu. Laparoscopic sleeve gastrectomy: how we do it and technical controversies[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(01): 5-8.

腹腔镜胃袖状切除术是目前最广泛开展的减重手术方式。关注其手术技术细节,力求规范化操作,对于保证手术质量、防止并发症发生至关重要。胃袖状切除操作细节各有不同。本文介绍了我们不同的做法,包括穿刺器放置、胃的游离、切割、标本取出,以及手术操作中怎样预防术后胃胸腔内移位等,并针对是否需要切缘加固缝合、预防术后胃胸腔内移位的措施、机器人与单孔腹腔镜胃袖状切除术(SG)手术价值进行了进一步讨论。

Laparoscopic sleeve gastrectomy is currently the most popularly performed bariatric technique. Focusing on the technical details of sleeve gastrectomy and striving for standardized procedures are essential to ensure surgical quality and prevent complications. Our different techniques, including placement of trocars, mobilization of the stomach, gastric transection, specimen retrieval, and how to prevent postoperative intrathoracic sleeve migration are described. Whether it’s necessary to do a staple line reinforcement in this procedure, preventive measures for postoperative intrathoracic sleeve migration, and the value of robotic or single-port sleeve gastrectomy are further discussed in this article.

图2 向远端游离,见胃窦部与胰腺之间的粘连,标志着远端游离到位
图4 于胃食管结合部向右打开上方脂肪,完整游离胃底,保持了膈食管韧带完整
图5 切割至胃底部时,向上挑起胃后壁,将其展平,保证切割均匀
[1]
American Society of Metabolic and Bariatric Surgery. Estimate of bariatric surgery numbers, 2011-2023.

URL    
[2]
杨华, 朱晒红, 王存川. 中国肥胖代谢外科数据库:2023年度报告[J/CD]. 中华肥胖与代谢病电子杂志, 2024, 10: 73-83.
[3]
Frosio F, Suhool A, Ferraz JM, et al. Anatomical quality criteria for sleeve gastrectomy [J]. Obes Surg, 2021, 31: 1541-1548.
[4]
Mahawar KK, Omar I, Singhal R, et al. The first modified Delphi consensus statement on sleeve gastrectomy [J]. Surg Endosc, 2021, 35: 7027-7033.
[5]
Meimand FE, Pazouki A, Setaredan SA, et al. The effect of antral resection start point on post sleeve gastrectomy gastroesophageal reflux symptoms and weight loss outcomes [J]. Surg Endosc, 2023, 37: 5158-5163.
[6]
朱江帆. 腹腔镜胃袖状切除术胃食管反流的预防和处理策略[J]. 中华消化外科杂志, 202423:1029-1033.
[7]
Karaman K, Aziret M, Ercan M, et al. A preventive strategy for staple line bleeding in morbidly obese patients undergoing sleeve gastrectomy [J]. J Laparoendosc Adv Surg Tech A, 2017, 27: 1015-1021.
[8]
Highet A, Johnson EH, Bonham AJ, et al. Cost-effectiveness of staple line reinforcement in laparoscopic sleeve gastrectomy [J]. Ann Surg, 2023, 277: 121-126.
[9]
Niaz O, Askari A, Currie A, et al. Analysis of the effect of staple line reinforcement on leaking and bleeding after sleeve gastrectomy from the UK National Bariatric Surgery Registry [J]. World J Surg, 2024, 48: 1950-1957.
[10]
Lossa A, Martini L, De Angelis F, et al. Leaks after laparoscopic sleeve gastrectomy: 2024 update on risk factors [J]. Langenbecks Arch Surg, 2024, 409: 249.
[11]
Zhu J. Suture or not suture: is staple line reinforcement necessary in laparoscopic sleeve gastrectomy?[J]. Obes Surg, 2022, 32: 2463-2464.
[12]
Sabry K, Elmaleh HM, EI-Swaify TE, et al. Surgical management algorithm for intrathoracic sleeve migration: a retrospective series and literature review [J]. J Laparoendosc Adv Surg Tech, 2022, 32: 1078-1091.
[13]
Hutopila I, Ciocoiu M, Paunescu L, et al. Reconstruction of the phrenoesophageal ligament (RPEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair [J]. Surg Endosc, 2023, 37: 3747–3759.
[14]
Paik B, Chung Y, Jeon D, et al. Intrathoracic sleeve migration following sleeve gastrectomy: incidence and outcomes [J]. Obes Surg, 2024, 34: 4425-4432.
[15]
Nosrati SS, Pazouki A, Sabzikarian M, et al. Can omentopexy reduce the incidence of gastroesophageal reflux disease after laparoscopic sleeve gastrectomy [J]. Obes Surg, 2021, 31: 274-281.
[16]
Spurzem GJ, Broderick RC, Kunkel EK, et al. Robotic sleeve gastrectomy has higher complication rates compared to laparoscopic: 8-year analysis of robotic versus laparoscopic primary bariatric surgery [J]. Surg Obesity Relat Dis, 2025, 21: 372–381.
[17]
张鹏, 张忠涛. 机器人辅助减重与代谢手术的发展历程、现状及未来趋势[J]. 中华普通外科杂志, 2024, 39: 241-245.
[18]
Hsu JL, Farrell TM. Updates in bariatric surgery [J]. Am Surg, 2024, 90: 925-933.
[19]
Zhu JF. Transumbilical endoscopic surgery: NOTES or TUES [J]. Surg Endosc, 2007, 21: 1898-1899.
[20]
Saber AA, Elgamal MH, Itawi EA, et al. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique [J]. Obes Surg, 200818: 1338-1342.
[21]
Nguyen NT, Hinojosa MW, Smith BR, et al. Single laparoscopic incision transabdominal (SLIT) surgery-adjustable gastric banding: a novel minimally invasive surgical approach[J]. Obes Surg, 2008, 18: 1628-1631.
[22]
Mauriello C, Chouillard E, d'alessandro A, et al. Retrospective comparison of single-port sleeve gastrectomy versus three-port laparoscopic sleeve gastrectomy: a propensity score adjustment analysis [J]. Obes Surg, 2018, 28: 2105-2112.
[23]
Tranchart H, Rebibo L, Gaillard M, et al. Shortterm outcomes of singleport versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis[J]. Surg Endos, 2020, 34: 3978-3985.
[24]
Lainas P, Derienne J, Dammaro C, et al. Single-port Laparoscopic Surgery for the Treatment of Severe Obesity: Review and Perspectives [J]. Obes Surg, 2020, 30: 2781-2790.
[1] 赵燕玲, 王珩, 秦勤, 李静. 不同手术在食管裂孔疝合并胃食管反流病患者中的应用观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 421-424.
[2] 王星棋, 申吉泓. 单支网片全尿道悬吊联合后盆生物力学重建术的临床应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 1-6.
[3] 魏子雯, 谢永怡, 郭洪瑞, 胡金奇, 李鹏. 机器人胃底折叠术治疗胃食管反流病的研究进展[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(04): 466-469.
[4] 嵇振岭, 刘宗航. 谈谈食管裂孔疝手术中食管裂孔缺损修补的方法[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(03): 245-252.
[5] 李世红, 牛钦王, 刘科豪, 余佳慧, 郭沛森, 张元川, 詹大方, 侯康, 聂攀. 右侧主操作联合常规胃短血管离断在腹腔镜Nissen 胃底折叠术中的临床效果分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(02): 167-171.
[6] 邱雨豪, 黄金向, 朱小轩, 罗峰, 黄河, 姚晖, 汪雪. 多学科诊疗联合加速康复外科模式在食管裂孔疝诊疗中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(01): 56-62.
[7] 张峥祥, 高龙, 李文. 柴胡疏肝散对胃食管反流病患者的效果及细胞因子、肠道菌群水平的影响[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(06): 590-593.
[8] 郝立婷, 马金鑫, 刘耀龙. 超声结合血清胃泌素17、胃蛋白酶对胃食管反流病的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(04): 376-380.
[9] 尹艳娟, 张宇, 张颖, 李晓珊, 郭全伟. 慢性咳嗽为表现的胃食管反流病患儿的胃超声造影及肠道菌群特征分析[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(03): 240-244.
[10] 唐欣然, 王翊钊, 刘明言, 马连君. 经口内镜下贲门缩窄术治疗胃食管反流病的有效性及安全性分析[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(04): 246-251.
[11] 丁明红, 刘佳. 胃食管反流病在不同维持治疗方法下的成本-效果分析[J/OL]. 中华胃食管反流病电子杂志, 2025, 12(01): 43-46.
[12] 韩琦, 李韶玲, 马建惠. 术中预防性护理干预对肥胖合并胃食管反流病患者术后并发症的影响[J/OL]. 中华胃食管反流病电子杂志, 2025, 12(01): 52-56.
[13] 康星, 夏雪峰, 俞杭, 褚薛慧, 孙喜太. 袖状胃切除术、单吻合口胃旁路术、袖状胃切除联合胃空肠吻合术治疗肥胖合并胃食管反流的疗效分析[J/OL]. 中华胃食管反流病电子杂志, 2025, 12(01): 10-16.
[14] 陈文辉, 刘燕, 胡瑞翔, 胡嵩浩, 姜舒文, 董志勇, 王存川. 功能性袖状胃切除术:一种新概念的减重手术方式[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(03): 163-169.
[15] 顾家宁, 韩国达, 闫昊然, 李正旗, 王亮. 体质量指数、2 型糖尿病、生活方式因素与胃食管反流病的关系:一项双样本孟德尔随机化研究[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(01): 53-61.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?