布拉格第一外科的减重手术：历史与一些技术层面的问题。

Fried M, Peskova M, Kasalicky M

1st Surgical Department, Charles University Teaching Hospital, Prague, Czech Republic.

Obes Surg. 1997 Feb;7(1):22-5. doi: 10.1381/096089297765556187.

BACKGROUND

Obesity has been increasing in the Czech Republic over the last 20 years. In 1983 we were one of the first surgical departments in the country which performed bariatric surgery on a regular basis.

METHODS

From 1983 to 1986 we performed vertical banded gastroplasty (VBG). Because of a high rate of various complications arising both from the stomach and the wound, we switched in 1986 to 'less aggressive' nonadjustable gastric banding (GB). In 1993 we performed the first laparoscopic nonadjustable banding, and in 1994 we started laparoscopic placement of adjustable gastric bands.

RESULTS

In the group of 52 patients who underwent VBG and were followed-up, acceptable weight loss results (-40.5 kg) were achieved in the 24 months following surgery. The postoperative complications were high; 17.3% gastric staple-line disruption and 15.3% wound complications (incisional hernias, discharge, etc.). Since 1986, we have performed nonadjustable GB in 150 patients and achieved weight loss of -38.4 kg in the 24 months following surgery. There was no change in the wound complication rate, but the complications arising from the stomach and the band decreased to 6.3%. Since June 1993, we have performed 268 procedures laparoscopically, either with nonadjustable bands or, since 1994, with the adjustable bands. The wound complication rate decreased to 0.9%, and one complication (6.6%) was related with the adjustable band.

CONCLUSIONS

Because of the high rate of postoperative complications in our experience with VBG, we started GB in 1986. Since then the number of complications arising from the stomach has decreased substantially. With the laparoscopic technique, there was a further decrease in wound healing problems. With the adjustable GB, a significant decrease in the stomach-related complications occurred. Shorter hospital stays were possible with the laparoscopic technique. Long-term weight loss results have not been significantly different among the above mentioned procedures.

背景

在过去20年里，肥胖症在捷克共和国呈上升趋势。1983年，我们是该国最早定期开展减肥手术的外科科室之一。

方法

1983年至1986年，我们开展了垂直捆绑胃成形术（VBG）。由于胃和伤口出现各种并发症的发生率较高，我们于1986年转而采用“创伤较小”的不可调节胃束带术（GB）。1993年，我们开展了首例腹腔镜不可调节胃束带术，1994年开始进行腹腔镜可调节胃束带植入术。

结果

在接受VBG并接受随访的52例患者中，术后24个月实现了可接受的体重减轻效果（减重40.5千克）。术后并发症发生率较高；胃吻合口破裂发生率为17.3%，伤口并发症发生率为15.3%（切口疝、引流等）。自1986年以来，我们对150例患者实施了不可调节胃束带术，术后24个月体重减轻了38.4千克。伤口并发症发生率没有变化，但胃和束带引起的并发症降至6.3%。自1993年6月以来，我们通过腹腔镜进行了268例手术，采用不可调节束带，或自1994年起采用可调节束带。伤口并发症发生率降至0.9%，1例并发症（6.6%）与可调节束带有关。