61 例 BMI 大于 70 的患者行非横断式开腹胃旁路术作为确定性减重术。
Non-transectional open gastric bypass as the definitive bariatric procedure for 61 patients with BMI of 70 and higher.
机构信息
Department of Surgery, UMDNJ, Camden, NJ, USA.
出版信息
Obes Surg. 2010 Jan;20(1):7-12. doi: 10.1007/s11695-009-9991-7. Epub 2009 Oct 14.
BACKGROUND
Technical difficulties in laparoscopic gastric bypass for severely obese patients have led to sleeve gastrectomy first and then laparoscopic gastric bypass as a second stage after significant weight loss. Rather than commit these fragile patients to two operations, we have done open gastric bypass as a definitive surgical treatment for extreme obesity.
METHODS
Office records of 61 patients with body mass index (BMI) of 70 and higher were reviewed. All underwent non-transectional open gastric bypass with a 150 cm Roux limb. Data included age, sex, weight, BMI, co-morbidities, operative information, length of stay (LOS), surgical morbidity, and percent excess weight loss (%XSWL). Data are in median (range).
RESULTS
There were 21 (34%) men and 40 (66%) women: age, 37 years (19-53); pre-operative weight, 468 lb (300-650); and pre-operative BMI, 77 (70-95). Co-morbidities were diabetes mellitus, 26 (46%); hypertension, 26 (43%); sleep apnea, 61 (100%); gastroesophageal reflux disease, 20 (33%); and hypothyroid nine (15%). Incision length was 15 cm (12-20), abdominal wall fat thickness was 8 cm (5-13), operative time was 150 min (100-210), and estimated blood loss was 100 ml (25-750); post-op intensive care unit: yes 16 (26%) and no 44 (74%). LOS was 3 days for 44 patients (74%), 4 days for 11 (18%), 5 days for five (8%), and 7 days for one (1.6%). Post-operative morbidity was as follows: zero mortality, splenectomy, stoma leak, deep venous thrombosis, pulmonary embolus, GI bleeding, stomal ulcer, intestinal obstruction, fascial dehiscence, or 30-day readmission; wound infections in one (1.6%); skin wound separation in six (10%); pneumonia in one (1.6%); anemia in nine (14.8%); vitamin B(12) deficiency in six (10%); incisional hernia in 17 (28%); and gastric staple line disruption in two (3.3%). %XSWL were 51% in 1 year (28-84) and 60% in 2 years (27-97).
CONCLUSIONS
Non-transectional open gastric bypass for patients with BMI of 70 and higher is safe and effective as a one-stage operation for severe obesity.
背景
腹腔镜胃旁路术在严重肥胖患者中存在技术难题，因此我们先进行袖状胃切除术，待患者显著减重后再进行腹腔镜胃旁路术作为二期手术。为避免将这些脆弱的患者置于两次手术的风险中，我们选择开腹胃旁路术作为治疗极度肥胖的确定性手术。
方法
回顾了 61 例 BMI 为 70 及以上的患者的门诊病历。所有患者均接受非横断式开腹胃旁路术，使用 150cm 的 Roux 袢。数据包括年龄、性别、体重、BMI、合并症、手术信息、住院时间（LOS）、手术发病率和体重减轻百分比（%XSWL）。数据为中位数（范围）。
结果
21 例（34%）为男性，40 例（66%）为女性：年龄 37 岁（19-53 岁）；术前体重 468 磅（300-650 磅）；术前 BMI 为 77（70-95）。合并症包括糖尿病 26 例（46%）、高血压 26 例（43%）、睡眠呼吸暂停 61 例（100%）、胃食管反流病 20 例（33%）和甲状腺功能减退 9 例（15%）。切口长度为 15cm（12-20cm），腹壁脂肪厚度为 8cm（5-13cm），手术时间为 150 分钟（100-210 分钟），估计失血量为 100ml（25-750ml）；术后入住重症监护病房：16 例（26%）和 44 例（74%）。44 例患者（74%）的 LOS 为 3 天，11 例（18%）为 4 天，5 例（8%）为 5 天，1 例（1.6%）为 7 天。术后发病率如下：无死亡、脾切除术、吻合口漏、深静脉血栓形成、肺栓塞、胃肠道出血、吻合口溃疡、肠梗阻、筋膜裂开或 30 天内再入院；1 例（1.6%）发生伤口感染；6 例（10%）发生皮肤伤口分离；1 例（1.6%）发生肺炎；9 例（14.8%）发生贫血；6 例（10%）发生维生素 B12 缺乏症；17 例（28%）发生切口疝；2 例（3.3%）发生胃缝线断裂。1 年时的体重减轻百分比（%XSWL）为 51%（28-84%），2 年时为 60%（27-97%）。
结论
BMI 为 70 及以上的患者行非横断式开腹胃旁路术作为严重肥胖的一期手术是安全有效的。
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