中国实用外科杂志

中国实用外科杂志

• 论蓍 • 上一篇    下一篇

单中心1139例减重代谢手术经验总结

梁    辉，管    蔚，林士波，刘瑞萍，杨宁琍   

  1. 南京医科大学第一附属医院减重代谢外科，江苏南京  210029
  • 出版日期:2019-04-01 发布日期:2019-04-04

  • Online:2019-04-01 Published:2019-04-04

摘要：

目的    总结单中心2009—2017年减重代谢手术经验，探讨学科构建方法。方法    回顾性分析2009年10月至2017年12月南京医科大学第一附属医院减重代谢外科完成的1139例减重代谢手术病例资料，分析病例数发展趋势、学习曲线以及并发症发生情况。结果    减重代谢专科成立后手术量呈逐年增长的趋势，年平均增长率40.1%，以腹腔镜胃袖状切除术（LSG）及其附加空肠旁路术（LSG+JJB）为主。术后并发症以出血及漏为主，其中死亡1例，再手术6例，出院30 d内再入院21例。腹腔镜胃旁路术（LRYGB）的学习曲线为23例，LSG学习曲线为25例。LSG、LRYGB及LSG+JJB的1年多余体重减少率分别为83.0%、72.4%及82.3%。术后1、3、5年的随访率分别为95.0%、67.0%及52.0%。结论    减重代谢专科设立是手术例数大幅度增长的关键因素。通过系统专科培训，可以缩短腹腔镜减重代谢手术的学习曲线，多学科综合治疗协作组（MDT）以及围手术期流程化管理是卓越中心建设的重要环节。

关键词: 减重代谢外科, 学习曲线, 专科构建, 并发症

Abstract:

Bariatric and metabolic surgery: An experience summarization of 1139 cases from a single center        LIANG Hui，GUAN Wei，LIN Shi-bo，et al. Department of Bariatric and Metabolic Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
Corresponding author：LIANG Hui，E-mail：drhuiliang@126.com
Abstract    Objective    To summarize the experience of bariatric and metabolic surgery in a single center from 2009 to 2017 and explore the methods of the specialty construction of bariatric and metabolic surgery. Methods    The clinical data of 1139 cases of bariatric and metabolic procedures performed from October 2009 to December 2017 in Department of Bariatric and Metabolic Surgery，the First Affiliated Hospital of Nanjing Medical University  were analyzed retrospectively. Results    The case numbers increased annually after the foundation of bariatric and metabolic surgery with the annual growth rate of 40.1%. Bleeding and leakage were the main postoperative complications. Among them，there was one case of postoperative death，6 cases of re-operations within the 30-day after discharge，and 21 cases of 30-day postoperative readmission. The learning curve analysis indicated that learning time was 23 cases for laparoscopic gastric bypass and 25 cases for sleeve gastrectomy. The rates of 1-year excessive weight loss were 83.0% for gastric bypass，72.4% for sleeve gastrectomy，and 82.3% for sleeve gastrectomy plus jejunal bypass. The rates of 1，3 and 5-year follow-up were around 95.0%，67.0% and 52.0%. Conclusion    The foundation of bariatric and metabolic specialty is the key reason for the massive increase of surgical cases. The learning curve of laparoscopic bariatric and metabolic surgery can be shortened though systemic specialty training. The collaboration of multi-disciplinary team and the perioperative process management are the key points for the construction of an excellent center.

Key words: bariatric and metabolic surgery, learning curve, specialty construction, complication