针式与腹腔镜减重手术的技术可行性、结果和患者满意度：一项随机研究。

Technical Feasibility, Outcomes, and Patient Satisfaction After Needlescopic and Laparoscopic Bariatric Surgery: a Randomized Study.

机构信息

School of Medicine, Department of Surgery, Duke University, 407 Crutchfield St, Durham, NC, 27704, USA.

Department of Psychiatry, Duke University Medical Center, Durham, NC, 27704, USA.

出版信息

Obes Surg. 2021 Nov;31(11):5085-5091. doi: 10.1007/s11695-021-05675-5. Epub 2021 Sep 4.

DOI:10.1007/s11695-021-05675-5

PMID:34480720

Abstract

BACKGROUND

Needlescopic instruments create a 3-mm incision and may result in less pain and superior cosmesis. There is limited understanding of the effectiveness of needlescopic instruments in patients with a body mass index (BMI) > 35 kg/m. We report perioperative outcomes and perception of body image with use of needlescopic instruments after bariatric surgery.

METHODS

Laparoscopic bariatric procedures were performed on 30 adults at a single academic medical center from January to December 2017. Patients were randomized to conventional laparoscopy (LAP) or needlescopic (NEED) surgery. The Multidimensional Body-Self Relations Questionnaire (MBSRQ) and Patient Scar Assessment Questionnaire (PSAQ) were completed at 6 months and 1 year. Univariate analysis was performed on perioperative outcomes and survey scores.

RESULTS

Surgery was completed on patients in the LAP group (N = 13) and compared to the NEED group (N = 17). The mean BMI was 41.4 kg/m2 LAP and 41.1 kg/m2 NEED. The most common procedure was Roux-en-Y gastric bypass (RYGB), with 13 RYGB in LAP and 12 RYGB in NEED (P = 0.76).The operative time was not significantly different between the LAP and the NEED group (209.5 ± 66.1 vs 181.9 ± 58.1 min, P = 0.48). There was no leak or mortality in the 30-day follow-up period. Within MBSRQ, the patient's appearance self-evaluation score was similar between LAP and NEED (2.5 ± 0.6 vs 2.4 ± 0.6, P = 0.61). Within PSAQ, the mean satisfaction score for incision appearance was also similar between LAP and NEED (16.1± 2.9 vs 15.4 ± 4.6, P = 0.85). Incision-related perceptions remained consistent at 6 months and 1 year after bariatric surgery.

CONCLUSIONS

Needlescopic instruments are safe and a viable alternative to use during bariatric surgery. Appearance and perception of scar were similar between groups. Further studies with needlescopic instruments should include patients with a BMI > 35 kg/m and compare additional factors associated with body image.

摘要

背景

针式器械产生 3 毫米的切口，可能导致疼痛减轻和美容效果更好。对于 BMI（体重指数）>35kg/m2 的患者，对于针式器械的有效性的理解有限。我们报告在减重手术后使用针式器械的围手术期结果和对身体形象的感知。

方法

2017 年 1 月至 12 月，在一家学术医疗中心对 30 名成年人进行了腹腔镜减重手术。患者被随机分为常规腹腔镜（LAP）或针式（NEED）手术组。在 6 个月和 1 年时完成多维身体自我关系问卷（MBSRQ）和患者疤痕评估问卷（PSAQ）。对围手术期结果和调查评分进行单因素分析。

结果

LAP 组（N=13）和 NEED 组（N=17）完成了手术。LAP 组的平均 BMI 为 41.4kg/m2，NEED 组为 41.1kg/m2。最常见的手术是 Roux-en-Y 胃旁路术（RYGB），LAP 组有 13 例 RYGB，NEED 组有 12 例 RYGB（P=0.76）。LAP 组和 NEED 组的手术时间无显著差异（209.5±66.1 vs 181.9±58.1 min，P=0.48）。在 30 天的随访期间，没有漏诊或死亡。在 MBSRQ 中，LAP 和 NEED 患者的外观自我评估评分相似（2.5±0.6 vs 2.4±0.6，P=0.61）。在 PSAQ 中，LAP 和 NEED 的切口外观满意度评分也相似（16.1±2.9 vs 15.4±4.6，P=0.85）。减重手术后 6 个月和 1 年时，切口相关感知保持一致。