机器人辅助袖状胃切除联合胃底折叠治疗肥胖症合并食管裂孔疝的单中心回顾性分析
作者:
作者单位:

1.新疆医科大学 研究生院,新疆 乌鲁木齐830054;2.新疆维吾尔自治区人民医院 2. 普外微创研究所 3. 微创、疝与腹壁外科,新疆 乌鲁木齐830011;3.新疆维吾尔自治区胃食管反流病及减重代谢外科临床研究中心,新疆 乌鲁木齐830011

作者简介:

黎鑫,新疆医科大学博士研究生,主要从事减重代谢外科与胃食管反流疾病方面的研究。

通信作者:

克力木·阿不都热依木,Email: klm6075@163.com

基金项目:

国家自然科学基金资助项目(82060166)。


Robot-assisted synchronous sleeve gastrectomy and fundoplication surgery for obesity complicated with esophageal hiatal hernia: a single-center retrospective analysis
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Affiliation:

1.Graduate School, Xinjiang Medical University, Urumqi 830054, China;2.Institute of General Surgery and Minimally Invasive Surgery 3. Department of Minimally Invasive, Hernia and Abdominal Surgery, People's Hospital of Xinjiang Autonomous Region, Urumqi 830011, China;3.Clinical Research Center for Gastroesophageal Reflux Disease and Weight Loss and Metabolic Surgery of Xinjiang Uygur Autonomous Region, Urumqi 830011, China

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    摘要:

    背景与目的 肥胖症患者常常合并食管裂孔疝并伴有胃食管反流症状,袖状胃切除术后可能造成严重的并发症。机器人辅助系统具有学习曲线短且平缓、手术视野清晰立体以及手术操作精确且稳定等优势,在外科领域得以广泛推广。本研究探究机器人辅助袖状胃切除联合胃底折叠手术的可行性,从而为肥胖症合并食管裂孔疝患者提供更佳的治疗方案。方法 回顾性分析2019年3月—2021年12月期间49例肥胖症合并食管裂孔疝行袖状胃切除及胃底折叠手术治疗患者的临床资料。其中22例行机器人辅助袖状胃切除联合胃底折叠术(机器人组),27例行腹腔镜辅助袖状胃切除联合胃底折叠术(腹腔镜组)。比较两组患者围手术期相关临床指标的差异,并分析机器人组的治疗效果。结果 两组患者术前甘油三酯、术前空腹血糖、术后住院时间、并发症发生率差异无统计学意义(均P>0.05)。与腹腔镜组比较,机器人组平均手术时间延长(169.09 min vs. 143.33 min,P=0.023)、平均手术费增加(6.36万元vs. 5.40万元,P<0.001),但手术操作时间缩短(115.09 min vs. 134.19 min,P=0.047),出血量减少(25.45 mL vs. 40.00 mL,P=0.023)。两组患者术后1个月的BMI、多余体质量减少百分比(%EWL)、甘油三酯、空腹血糖以及GERD评分差异均无统计学意义(均P>0.05)。机器人组术后1个月的%EWL值(26.26%)达到了减重有效的水平,术后1个月的体质量、BMI、甘油三酯、空腹血糖以及GERD评分均较术前明显降低(均P<0.05)。结论 机器人辅助袖状胃切除联合胃底折叠手术能够使肥胖合并食管裂孔疝患者获得良好的减重效果,明显改善患者的代谢和胃食管反流症状,并且安全可靠,具有一定的可行性。但手术费用较高的问题亟待解决,在选择手术方式时应充分考虑患者家庭经济情况。

    Abstract:

    Background and Aims Obesity patients are often complicated with hiatal hernia and gastroesophageal reflux symptoms, which may cause severe complications after sleeve gastrectomy. The robot-assisted system has the advantages of a short and gentle learning curve, a transparent and three-dimensional surgical field of vision, and accurate and stable surgical operation, which has been widely promoted in the surgical field. This study assessed the feasibility of robot-assisted sleeve gastrectomy plus Nissen fundoplication surgery to provide a better treatment scheme for obese patients with hiatal hernias.Methods The clinical data of 49 patients with obesity and concomitant hiatus hernia undergoing sleeve gastrectomy plus fundoplication surgery between March 2019 and December 2021 were retrospectively reviewed. Of the patients, 22 cases underwent robot-assisted sleeve gastrectomy combined with fundoplication (robotic group), and 27 cases underwent laparoscopic-assisted sleeve gastrectomy combined with fundoplication (laparoscopic group). The differences in perioperative clinical variables between the two groups were compared, and the treatment efficacy in the robotic group was analyzed.Results There were no significant differences in preoperative triglyceride level, preoperative fasting glucose level, length of postoperative hospital stay, and incidence of complications between the two groups (all P>0.05). In the robotic group compared to the laparoscopic group, the average total operation duration was prolonged (169.09 min vs. 143.33 min, P=0.023) and the average surgical cost was increased (63 600 yuan vs. 54 000 yuan, P<0.001), but the average operative time was shortened (115.09 min vs.134.19 min, P=0.047), and the average blood loss was reduced (25.45 mL vs. 40.00 mL, P=0.023). there were no statistical differences in BMI, percentage of excess weight loss (%EWL), triglyceride level, fasting blood glucose level, and GERD score between the two groups at one month after operation (all P>0.05). In robotic group at 1 month after the operation, the %EWL value (26.26%) reached the weight loss goal, and the weight, BMI, triglyceride level, fasting blood glucose level and GERD score were significantly decreased compared with the preoperative values (all P<0.05).Conclusion Robot-assisted sleeve gastrectomy combined with fundoplication surgery yields good weight loss results and significantly improves the metabolic and gastroesophageal reflux symptoms in obese patients with hiatal hernia, and is safe and reliable, with certain feasibility. However, there is still an urgent problem of high surgical cost, and the patient's family economic situation should be fully considered when choosing the surgical approach.

    图1 机器人术中探查发现食管裂孔疝Fig.1 Detection of esophageal hiatal hernia during robotic surgery
    图2 机器人辅助袖状胃切除联合胃底折叠手术 A:充分解剖游离疝囊,暴露双侧膈肌脚;B:无损伤线关闭缩小食管裂孔;C:袖状胃切除后保留部分胃底;D:胃底折叠后折叠瓣固定于膈肌脚Fig.2 Robot-assisted sleeve gastrectomy combined with fundoplication surgery A: Full dissection of the free hernia sac and exposure of the bilateral diaphragmatic crura; B: Closure of the esophageal hiatus with atraumatic suture; C: Leaving part of the gastric fundus unresected after sleeve gastrectomy; D: Fixation of the folding flap to the diaphragmatic crura after fundoplication
    图1 机器人术中探查发现食管裂孔疝Fig.1 Detection of esophageal hiatal hernia during robotic surgery
    图2 机器人辅助袖状胃切除联合胃底折叠手术 A:充分解剖游离疝囊,暴露双侧膈肌脚;B:无损伤线关闭缩小食管裂孔;C:袖状胃切除后保留部分胃底;D:胃底折叠后折叠瓣固定于膈肌脚Fig.2 Robot-assisted sleeve gastrectomy combined with fundoplication surgery A: Full dissection of the free hernia sac and exposure of the bilateral diaphragmatic crura; B: Closure of the esophageal hiatus with atraumatic suture; C: Leaving part of the gastric fundus unresected after sleeve gastrectomy; D: Fixation of the folding flap to the diaphragmatic crura after fundoplication
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黎鑫,艾克拜尔·艾力,阿力木江·麦斯依提,王志,蒋媛,伊比提哈尔·买买提艾力,克力木·阿不都热依木.机器人辅助袖状胃切除联合胃底折叠治疗肥胖症合并食管裂孔疝的单中心回顾性分析[J].中国普通外科杂志,2022,31(10):1347-1354.
DOI:10.7659/j. issn.1005-6947.2022.10.010

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  • 收稿日期:2022-07-29
  • 最后修改日期:2022-09-17
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  • 在线发布日期: 2022-10-31