单吻合口胃旁路手术的学习曲线及其作为Roux-en-Y胃旁路手术前置手术的影响：105例连续病例的初步经验
The learning curve of one anastomosis gastric bypass and its impact as a preceding procedure to Roux-en Y gastric bypass: initial experience of one hundred and five consecutive cases.
作者信息
Lo Hung-Chieh
机构信息
Division of Trauma and Emergency Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan, Republic of China.
School of Medicine, College of Medicine, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan, Republic of China.
出版信息
BMC Surg. 2020 Feb 26;20(1):37. doi: 10.1186/s12893-020-00697-9.
BACKGROUND
The aim of this study was to assess the learning curve of one anastomosis gastric bypass (OAGB-MGB) at the start of a low volume bariatric unit and analyze its impact as a preceding procedure to Roux-en Y gastric bypass (RYGB).
METHODS
From January 2014 to December 2017, all patients who underwent bariatric surgeries in our teaching hospital that were performed by the same surgeon were enrolled. The first 47 patients who underwent OAGB-MGB were assigned to group A. RYGB has been offered as a treatment option since July 2016; thereafter, 26 patients who underwent OAGB-MGB and 32 patients who underwent RYGB at the same time interval were assigned to group B and group C, respectively. Baseline characteristics, perioperative outcomes and percentage of total weight loss (%TWL) up to 12 months postoperatively were collected and analyzed between groups.
RESULTS
Compared to the patients in group C, those in groups A and B were older (39.4 yrs. and 42.2 yrs., respectively, vs. 34.2 yrs.; p = 0.021) and predominantly male (48.9 and 73.1%, respectively vs. 40.6%; p = 0.04), and they had a higher body mass index (41.8 kg/m and 43.3 kg/m, respectively vs. 37.7 kg/m; p = 0.002) and a higher incidence of hypertension (44.7 and 61.5%, respectively vs. 21.9%; p = 0.008). In addition, the operation time was significantly reduced (118.2 min and 115.8 min, respectively vs. 153.1 min; p < 0.001), and the length of stay was shortened (3.0 days and 2.9 days, respectively vs. 3.4 days; p = 0.002) in groups B and C compared to group A. No mortality, conversion or leakage was reported throughout the study period. The 30-day complication rate was decreased in group C compared to groups A and B (0% vs. 6.4 and 7.7%, respectively; p = 0.307). The %TWL at the 12-month follow-up was 36.3, 30.9 and 28.3% for groups A, B and C, respectively (p < 0.001).
CONCLUSION
Our study verified the early emergence of a learning curve effect for OAGB-MGB, and the proficiency acquired can be transferred to subsequent practice for RYGB in terms of acceptable operation time and length of stay without an increase in complications.
背景
本研究的目的是评估在一个低容量减肥手术科室开展单吻合口胃旁路术（OAGB - MGB）的学习曲线，并分析其作为Roux - en Y胃旁路术（RYGB）前置手术的影响。
方法
2014年1月至2017年12月，纳入在我们教学医院由同一位外科医生进行减肥手术的所有患者。最初接受OAGB - MGB的47例患者被分配到A组。自2016年7月起RYGB被作为一种治疗选择；此后，在相同时间间隔内接受OAGB - MGB的26例患者和接受RYGB的32例患者分别被分配到B组和C组。收集并分析各组之间的基线特征、围手术期结局以及术后12个月的总体重减轻百分比（%TWL）。
结果
与C组患者相比，A组和B组患者年龄更大（分别为39.4岁和42.2岁，对比34.2岁；p = 0.021）且男性占比更高（分别为48.9%和73.1%，对比40.6%；p = 0.04），他们的体重指数更高（分别为41.8kg/m²和43.3kg/m²，对比37.7kg/m²；p = 0.002），高血压发病率更高（分别为44.7%和61.5%，对比21.9%；p = 0.008）。此外，与A组相比，B组和C组的手术时间显著缩短（分别为118.2分钟和115.8分钟，对比153.1分钟；p < 0.001），住院时间缩短（分别为3.0天和2.9天，对比3.4天；p = 0.002）。在整个研究期间未报告死亡、中转或渗漏情况。与A组和B组相比，C组的30天并发症发生率降低（分别为0%对比6.4%和7.7%；p = 0.307）。A、B、C组在12个月随访时的%TWL分别为36.3%、30.9%和28.3%（p < 0.001）。
结论
我们的研究证实了OAGB - MGB学习曲线效应的早期出现，并且所获得的熟练程度可以在可接受的手术时间和住院时间方面转移到后续的RYGB手术实践中，而不会增加并发症。
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