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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) ›› 2026, Vol. 20 ›› Issue (01) : 18 -21. doi: 10.3877/cma.j.issn.1674-3946.2026.01.007

论著

单孔腹腔镜袖状胃切除术围手术期血液管理措施的比较研究
康星1, 俞杭1,2, 单晓东1, 孙喜太1, 褚薛慧1,†()   
  1. 1210008　南京，南京大学医学院附属鼓楼医院胰腺与代谢外科
    2210046　南京，南京大学医学院附属泰康仙林鼓楼医院普外科
  • 收稿日期:2025-02-01 出版日期:2026-02-26
  • 通信作者: 褚薛慧

A comparative study on perioperative blood management measures in single-port laparoscopic sleeve gastrectomy

Xing Kang1, Hang Yu1,2, Xiaodong Shan1, Xitai Sun1, Xuehui Chu1,†()   

  1. 1Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing Jiangsu Province 210008, China
    2Department of Surgery, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing Jiangsu Province 210046, China
  • Received:2025-02-01 Published:2026-02-26
  • Corresponding author: Xuehui Chu
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康星, 俞杭, 单晓东, 孙喜太, 褚薛慧. 单孔腹腔镜袖状胃切除术围手术期血液管理措施的比较研究[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(01): 18-21.

Xing Kang, Hang Yu, Xiaodong Shan, Xitai Sun, Xuehui Chu. A comparative study on perioperative blood management measures in single-port laparoscopic sleeve gastrectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(01): 18-21.

目的

比较不同血液管理措施在单孔腹腔镜袖状胃切除术围手术期的效果。

方法

回顾性分析2024年1月至2024年10月于南京大学医学院附属鼓楼医院减重代谢外科行单孔腹腔镜下袖状胃切除术的86例患者的临床数据，根据患者是否进行围手术期血液管理分为实验组（n=40，实施围手术期血液管理，包括静脉输注铁剂等）和对照组（n=46，未实施围手术期血液管理）。采用SPSS 27.0软件分析数据。数据用（±s）或[例（%）]表述，采用t、χ2或Fisher精确概率检验。P<0.05为差异有统计学意义。

结果

实验组患者手术时间、术后排气时间和术后血红蛋白水平下降和术中出血量均少于对照组（P<0.05）；实验组患者术后D-二聚体和纤维蛋白原水平高于对照组，但差异无统计学意义（P>0.05）；实验组患者术后中性粒细胞百分比、C反应蛋白水平均显著低于对照组（P<0.05）；术后并发症及不良反应的发生率，对照组数值略高于实验组，但差异无统计学意义（P>0.05）。

结论

单孔腹腔镜袖状胃切除术围手术期行血液管理措施对于患者的预后起到至关重要的作用，对于术前合并贫血和凝血指标异常的患者，应常规予相应血液管理措施，以提升手术疗效、改善患者预后。

关键词: 肥胖症, 单孔腹腔镜袖状胃切除术, 血液管理
Objective

To compare the effects of different perioperative blood management measures in single-port laparoscopic sleeve gastrectomy.

Methods

The clinical data of 86 patients who underwent single-port laparoscopic sleeve gastrectomy in the Department of Bariatric and Metabolic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School from January 2024 to October 2024 were retrospectively analyzed. The patients were divided into the experimental group (n=40 perioperative blood management was implemented, including intravenous iron infusion, etc.) and the control group (n=46, no perioperative blood management was implemented). Data were analyzed using SPSS 27.0 software. Data were expressed as (±s) or [cases (%)]. t test, χ2 test or Fisher’s exact probability test were used. P<0.05 was considered statistically significant.

Results

The operation time, postoperative exhaust time, postoperative hemoglobin level decline and intraoperative blood loss in the experimental group were all less than those in the control group (P<0.05); the postoperative D-dimer and fibrinogen levels in the experimental group were higher than those in the control group, but the difference was not statistically significant (P>0.05); the postoperative neutrophil percentage and C-reactive protein level in the experimental group were significantly lower than those in the control group (P<0.05); the incidence of postoperative complications and adverse reactions in the control group was slightly higher than that in the experimental group, but the difference was not statistically significant (P>0.05).

Conclusion

Perioperative blood management measures in single-port laparoscopic sleeve gastrectomy play a crucial role in the prognosis of patients. For patients with preoperative anemia and abnormal coagulation indicators, corresponding blood management measures should be routinely implemented to improve surgical efficacy and patient prognosis.

Key words: Obesity, Single Incision Laparoscopic Sleeve Gastrectomy, Blood Management
表1 两组行单孔腹腔镜下袖状胃切除术患者一般资料比较
组别 例数 性别（例） 年龄（岁，±s） 体重（kg，±s） BMI（kg/m2，±s） 输血史[例（%）]
男/女
实验组 40 15/25 27.8±8.2 148.6±48.5 36.5±4.7 2（5.0）
对照组 46 17/29 28.5±7.5 152.3±51.3 37.2±4.9 1（2.2）
t/χ2值     -1.256 0.893 1.243 <0.001
P值     0.157 0.125 0.114 1.151
组别 例数 腹部手术史[例（%）] 白细胞（×109/L，±s） 血红蛋白（g/L，±s） D-二聚体（mg/L，±s） 纤维蛋白原（g/L，±s）
实验组 40 4（10.0） 8.6±1.6 123.7±2.3 0.3±0.2 3.8±0.8
对照组 46 3（6.5） 8.3±1.2 124.7±3.8 0.2±0.1 3.2±0.8
t/χ2值   <0.001 -1.354 0.812 1.456 -2.354
P值   0.721 0.187 0.158 0.387 0.354
表2 两组行单孔腹腔镜下袖状胃切除术患者围手术期指标比较（±s）
组别 例数 手术时间（min） 术后排气时间（h） 术后血红蛋白下降（g/L） 术中出血量（ml） D-二聚体（mg/L）
实验组 40 68.0±23.0 20.0±5.0 3.0±2.0 20.0±8.0 0.4±0.2
对照组 46 75.0±28.0 25.0±8.0 8.0±3.0 24.0±5.0 0.2±0.1
t值   -3.643 -4.157 -5.433 -2.564 -1.823
P值   0.001 <0.001 <0.001 0.002 0.180
组别 例数 纤维蛋白原（g/L） 中性粒细胞百分比（%） C反应蛋白（mg/L） 白细胞（×109/L） 术后住院时间（d）
实验组 40 5.2±0.4 80.0±3.0 13.1±5.6 13.6±4.1 3.0±1.0
对照组 46 3.1±0.6 86.0±4.0 17.8±9.3 14.8±3.7 3.0±2.0
t值   -3.821 -3.657 -2.257 -2.451 -3.541
P值   0.150 <0.001 <0.001 0.506 0.638
表3 两组行单孔腹腔镜下袖状胃切除术患者术后并发症比较[例（%）]
组别 例数 头晕 心悸 发热 心律失常 下肢深静脉血栓 总并发症
实验组 40 0（0.0） 0（0.0） 3（7.5） 0（0.0） 0（0.0） 3（7.5）
对照组 46 2（4.3） 1（2.2） 5（10.9） 1（2.2） 1（2.2） 10（21.7）
χ2值   -2.569 -5.312 -2.346 -2.924 -3.294 -2.584
P值   0.071 0.139 0.264 0.088 0.063 0.073
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