中国实用外科杂志

中国实用外科杂志

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超级肥胖病人行腹腔镜胃袖状切除术应用加速康复外科路径效果研究

孙龙昊，梁晓宇，徐梦瑜，白晓温，张    杨，陈    岩，刘    彤   

  • 出版日期:2021-10-01

  • Online:2021-10-01

摘要： 目的    探讨超级肥胖病人腹腔镜胃袖状切除术（LSG）围手术期应用快速康复外科（ERAS）路径的安全性和近期效果。方法　回顾性分析2017年1月至2021年3月天津医科大学总医院普通外科收治的200例肥胖病人临床资料，所有病人均进入ERAS路径，并接受LSG。比较肥胖组（BMI 27.5~<50，156例）和超级肥胖组（BMI≥50，44例）病人术中及术后情况。结果   ERAS路径总体完成率和各具体流程组间差异无统计学意义（P>0.05）。与肥胖组比较，超级肥胖组中术前美国麻醉医师协会（ASA）分级Ⅲ级比例显著高于肥胖组（56.8 vs. 14.1%，P<0.0001），手术时间显著延长［（149.4±41.8）min vs. （132.4±45.2）min，P<0.05］，术后入住重症监护室（ICU）比例显著增高（22.7% vs. 3.2%，P<0.0001）。两组病人术中使用吻合器钉仓数量、术中非计划增加Trocar孔数的病例比例、住院时间、术后住院时间差异均无统计学意义（P>0.05）。术后30 d内共发生术后并发症51例次，无30 d非计划再手术病人，30 d非计划再入院病人8例，且均为肥胖组病人。超级肥胖组病人术后30 d绝对体重减少［（21.1±7.1）kg vs. （13.2±3.6）kg，P<0.0001］、绝对BMI减少（7.3±2.7 vs. 4.6±1.1，P<0.0001）、总体重减少百分比［（13.7±5.1）% vs. （11.9±2.6）%，P<0.01］均显著高于肥胖组；额外体重减少百分比［（25.7±9.9）% vs.（39.0±19.7）%，P<0.0001）］和额外BMI减少百分比［（25.7±9.9）% vs.（39.0±19.7）%，P<0.0001］均显著低于肥胖组。结论　对超级肥胖病人使用ERAS路径安全有效，并未增加围手术期并发症发生率及非计划再入院率，但应加强围手术期监护，强化心肺等器官功能支持治疗。

关键词: 病态性肥胖, 腹腔镜胃袖状切除术, 加速康复外科, 超级肥胖

Abstract: Effect of enhanced recovery after surgery protocol on laparoscopic sleeve gastrectomy in super-obese patients            SUN Long-hao，XU Meng-yu，BAI Xiao-wen，et al. Department of General Surgery，Tianjin Medial University General Hospital，Tianjin 300052，China
Corresponding author: LIANG Xiao-yu，E-mail: liangxiaoyu2025@hotmail.com；LIU Tong，E-mail: liutonga@126.com
Abstract    Objective    To investigate the perioperative outcomes and safety with enhanced recovery after surgery (ERAS)  pathways in super-obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Methods    The clinical data of 200 obese patients in Department of General Surgery of Tianjin Medical University General Hospital from January 2017 to March 2021 were retrospectively analyzed. All the patients entered the ERAS pathways and underwent LSG. Patients were subdivided into obesity group (BMI 27.5~<50，156 cases) and super-obesity group(BMI≥50，44 cases)，and intraoperative and postoperative data were compared between groups. Results    There was no significant difference of overall and sub-process completion rate of ERAS protocol between groups (P>0.05). Compared with the obese group，the proportion of ASA Ⅲ in the super obese group was significantly increased (56.8 vs. 14.1%，P<0.0001)，the operation time was significantly prolonged (149.4±41.8 vs. 132.4±45.2 min，P<0.05)，and the proportion of ICU admission was significantly increased (22.7% vs. 3.2%，P<0.0001) in the super obese group. There was no significant difference between the two groups in the number of staplers used during operation，the proportion of cases with unplanned increase of trocar during operation，the length of hospital stay and postoperative hospital stay (P>0.05). There were 51 cases of postoperative complications，8 patients with unplanned readmission，and no patients with unplanned reoperation within 30 days after operation. The absolute weight loss (21.1±7.1 vs. 13.2±3.6kg，P<0.0001)，absolute BMI loss (7.3±2.7 vs. 4.6±1.1kg/m2，P<0.0001)，%TWL (13.7±5.1% vs. 11.9±2.6%，P<0.01) of super obesity group were significantly higher than those of obesity group. The %EWL (39.0±19.7% vs. 25.7±9.9%，P<0.0001)，and %EBMIL (39.0±19.7% vs. 25.7±9.9%，P<0.0001) of super obesity group were significantly lower than those of obesity group. Conclusion    The clinical application of ERAS pathways for super obese patients is safe and effective，without increasing the incidence of perioperative complications and unplanned readmission rate. However，for the super obese patients，the intensive monitoring and organ supporting therapy after the operation should be strengthened.

Key words: morbid obesity, laparoscopic sleeve gastrectomy, enhanced recovery after surgery, super-obesity