开放手术与腹腔镜下Roux-en-Y胃旁路手术：手术发病率和死亡率的比较

Open vs laparoscopic Roux-en-Y gastric bypass: comparison of operative morbidity and mortality.

作者信息

Smith Sherman C, Edwards Charles B, Goodman Gerald N, Halversen R Chad, Simper Steven C

机构信息

Rocky Mountain Associated Physicians, Salt Lake City, UT 84124, USA.

出版信息

Obes Surg. 2004 Jan;14(1):73-6. doi: 10.1381/096089204772787329.

DOI:10.1381/096089204772787329

PMID:14980037

Abstract

BACKGROUND

Open Roux-en-Y gastric bypass (RYGBP) has proven to be an effective method for weight control for the morbidly obese patient. With technologic and surgical skill advancement in the application of laparoscopic surgery, laparoscopic RYGBP has also been found to be of value in surgical control of obesity. Risk/benefit ratios in comparison of the 2 methods are undergoing definition by experience.

METHODS

779 patients who underwent RYGBP between March 1, 2000 and June 30, 2002 were evaluated retrospectively. 328 patients underwent laparoscopic RYGBP (Group A) and 451 underwent open RYGBP (Group B). All charts and hospital records of these patients were reviewed. Questionnaires were mailed to all patients who had undergone RYGBP. Follow-up was 5-29 months.

RESULTS

89 patients in Group A and 162 patients in Group B experienced significant morbidity. There were no surgical deaths in Group A and one surgical death in Group B. Weight loss profiles were the same. Significant differences in morbidity were noted with respect to gastrojejunal stenosis (Group A = 11.6%, Group B = 4.7%, P=.0012), occurrence of ventral incisonal hernia (A=0%, B=10%, P<.00013), and wound problems (abdominal wall hematoma A=1.5%%, B=0%, P=.013; wound infection A=1.2%, B=6.2%, P=.00037). Gastrojejunal perforation was not significantly different (A=1.5%, B=0.89%, P=.50), as was true of small bowel obstruction (A=2.7%, B=3.3%, P=.68).

CONCLUSIONS

Each operative approach has associated problems.Wound care problems and ventral hernias are more common in Group B (open) and anas tomotic stenoses are more common in Group A (laparoscopic). Anastomotic leaks and small bowel obstruction are troublesome but not statistically different in occurrence.

摘要

背景

开放式Roux-en-Y胃旁路术（RYGBP）已被证明是病态肥胖患者控制体重的有效方法。随着腹腔镜手术应用中技术和手术技巧的进步，腹腔镜RYGBP在肥胖症的手术治疗中也被发现具有价值。这两种方法的风险/收益比正在通过经验来确定。

方法

对2000年3月1日至2002年6月30日期间接受RYGBP手术的779例患者进行回顾性评估。328例患者接受腹腔镜RYGBP（A组），451例接受开放式RYGBP（B组）。对这些患者的所有病历和医院记录进行了审查。向所有接受过RYGBP手术的患者邮寄了问卷。随访时间为5 - 29个月。

结果

A组89例患者和B组162例患者出现明显并发症。A组无手术死亡病例，B组有1例手术死亡。体重减轻情况相同。在胃空肠狭窄方面（A组 = 11.6%，B组 = 4.7%，P = 0.0012）、腹直肌切口疝的发生率（A组 = 0%，B组 = 10%，P < 0.00013）以及伤口问题（腹壁血肿A组 = 1.5%，B组 = 0%，P = 0.013；伤口感染A组 = 1.2%，B组 = 6.2%，P = 0.00037）方面，并发症存在显著差异。胃空肠穿孔无显著差异（A组 = 1.5%，B组 = 0.89%，P = 0.50），小肠梗阻情况也无显著差异（A组 = 2.7%，B组 = 3.3%，P = 0.68）。