腹腔镜袖状胃切除术19例围手术期的护理

病态肥胖严重影响身心健康和生活质量,常并发呼吸、循环等系统的一系列生理、病理改变[1].手术能获得持久的减肥效果[2].近3 a来,我院开展了腹腔镜袖状胃切除术治疗病态肥胖共19例,疗效满意,现将围手术期护理体会报告如下.     

袖状胃切除术对糖代谢的影响

目的:通过建立几种不同袖状胃切除模型,探讨袖状胃切除术对糖代谢的影响。方法:分别在肥胖诱导大鼠(F组)、糖尿病GK鼠(D组)、普通Wistar大鼠(C组)建立袖状胃切除模型,术后连续观察8周,比较3组术后体重、摄食和外周血活性Ghrelin、GLP-1、胰岛素及血糖浓度的变化。结果:与C组相比,F组大鼠与D组大鼠体重下降且摄食量减少,血糖改善(P<0.05),F组大鼠与D组大鼠外周血活性Ghrelin浓度下降,GLP-1浓度升高(P<0.05)。结论:袖状胃切除术在肥胖及2型糖尿病大鼠模型上能有效改善糖代谢。     

腹腔镜袖状胃切除治疗肥胖合并2型糖尿病的临床研究

目的探讨肥胖合并2型糖尿病(T2DM)患者行腹腔镜袖状胃切除术(LSG)治疗的效果。方法选取2017年12月至2020年1月在郑州大学附属郑州中心医院治疗的126例肥胖合并T2DM患者,将其分为两组。对照组42例,采取腹腔镜下胃旁路术治疗;观察组84例,采取LSG治疗。比较两组患者的手术指标、血糖控制指标及体质指数(BMI)。结果两组患者的出血量、手术操作时间、术后肛门排气时间比较差异未见统计学意义(P 0.05)。术后6个月,观察组患者的空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(Hb A1c)等血糖指标高于对照组(P 0.05);两组患者的BMI比较,差异未见统计学意义(P 0.05)。结论 LSG治疗肥胖合并T2DM控制体质量效果及手术效果与胃旁路术相当,但控制血糖效果弱于胃旁路术。     

腹腔镜袖状胃切除治疗病态性肥胖护理难点及效果评价

【】目的 探讨腹腔镜袖状胃切除术(Laparoscopic Sleeve Gastrectomy,LSG)于围手术期可能出现的护理难点及其特点,总结临床经验,采取相应的护理措施和应用要点。方法 回顾性分析我院2014年1月-2015年6月行腹腔镜袖状胃切除术治疗病态肥胖症病例60例的临床资料。结果 59例成功在腹腔镜下完成手术,无中转开腹,1例未完成手术。平均手术时间为(115.8 18.4)min,平均术中出血量为(120.6 35.2)ml。术后3个月患者随访过程中,发现患者体重、腰围及血糖等体质呈明显下降趋势。结论 腹腔镜袖状胃切除术被广泛视为减重手术中既安全又有效,同时并发症较少的手术方式,在腹腔镜袖状胃切除术围手术期护理中,肥胖患者的护理具有一定难点、特殊性及挑战性,针对这些护理难点需采取相应的护理措施以保证患者围手术期安全。     

1例经脐单孔袖状胃切除术护理体会

<正>肥胖是全球的高发病之一,肥胖及相关代谢疾病严重影响了患者的生存时间和生活质量[1]。代谢手术是治疗肥胖长期有效的方法,并成为临床上常规治疗项目[2]。袖状胃切除术是一种新兴的代谢手术术式,具有不改变胃肠道生理结构、不造成营养缺乏的优势,临床上应用较广泛[3]。常规的袖状胃切除手术均可在腹腔镜下完成,传统的腹腔镜手术需在体表进行多点穿刺,术后腹壁上会留下4~5个手术瘢痕,影响美观。微创术     

Roux-en-Y胃旁路术与袖状胃切除术治疗肥胖症合并2型糖尿病的效果比较

目的比较Roux-en-Y胃旁路术与袖状胃切除术治疗肥胖症合并2型糖尿病的临床效果。方法将68例肥胖症合并糖尿病患者依据性别、体重进行分层随机分组,观察组34例采用袖状胃切除术治疗,对照组34例采用Roux-en-Y胃旁路术治疗。比较2组术前与术后3、6、12个月体重、体质量指数(BMI)、腰围及血糖相关指标[空腹血糖(FPG)、糖化血红蛋白(HbAlc)、胰岛素抵抗指数(HOMA-IR)]的变化情况,观察2组术后并发症发生情况。结果2组术前体重、BMI、腰围、FPG、HbAlc、HOMA-IR各项指标比较差异均无统计学意义(P>0.05);2组术后3、6、12个月各项指标均较术前显著降低(P<0.05),但2组术后各时间点各项指标比较差异均无统计学意义(P>0.05)。观察组术后并发症发生率为5.88%,显著低于对照组的23.53%,差异有统计学意义(χ^2=4.221、P=0.039)。结论Roux-en-Y胃旁路术与袖状胃切除术均可有效治疗肥胖症合并2型糖尿病,但袖状胃切除术的术后并发症较少,术前需根据患者病情选择合适术式。     

1例病态性肥胖病人行袖状胃切除术的护理难点及对策

<正>肥胖症是由于营养物质过剩,导致体内脂肪堆积引起的一种慢性代谢性疾病。病态性肥胖是指体质指数(BMI)≥40 kg /m2或BMI≥35 kg/m2且合并2型糖尿病、高血压、高脂血症等代谢性疾病,可严重减低病人生活质量,缩短病人实际寿命[1]。目前普遍认为,减肥手术是病态肥胖者控制体重和减轻肥胖相关并发症的最有效方法之一[2]。腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG) 是近年来出现的一种     

延续性护理对腹腔镜袖状胃切除术治疗肥胖症合并2型糖尿病近远期疗效的影响观察

目的：探讨延续性护理对腹腔镜袖状胃切除术治疗肥胖症合并2型糖尿病患者近远期疗效的影响。方法选取我院2013年8月至2014年11月行腹腔镜袖状胃切除术治疗的肥胖症合并2型糖尿病患者72例为研究对象,以随机数字表法分组,对照组36例出院后接受常规随访,观察组36例接受延续性护理,对两组患者术后近远期效果进行观察。结果术前两组患者腰围、体重、BMI指数无明显差异( P>0.05),观察组术后3个月、6个月、12个月的腰围、体重及BMI指数与对照组相比,差异有统计学意义( P<0.05);术前两组患者HbA1 c、空腹血糖及胰岛素抵抗指数均无明显差异( P>0.05),术后3个月、6个月、12个月均有明显变化,且观察组各项指标水平与对照组相比差异显著( P<0.05)。结论肥胖症合并2型糖尿病患者接受腹腔镜袖状胃切除术具有良好效果,出院后应用延续性护理可与手术治疗相互配合,增强疗效,利于患者病情控制,改善远期预后,值得推广。     

腹腔镜袖状胃切除对肥胖患者炎症因子水平的影响

目的探讨腹腔镜下袖状胃切除术(LSG)对肥胖患者全身炎症因子水平的影响。方法选取腹腔镜下袖状胃切除术肥胖患者20例,比较患者术前、术后3个月血清C反应蛋白(CRP)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平。结果本组肥胖患者术前体质量、BMI依次为(131. 00±13. 44) kg、(44. 30±3. 99) kg/m~2,行腹腔镜袖状胃切除术后3个月体质量、BMI依次为(111. 25±9. 21) kg、(37. 65±2. 88) kg/m~2,差异有统计学意义(P 0. 05)。与术前相比,本组肥胖患者腹腔镜袖状胃切除手术后3个月血清CRP、IL-6、IL-8、TNF-α水平均显著下降(P 0. 05)。结论腹腔镜下袖状胃切除术能减轻体质量,降低肥胖患者全身炎症因子水平。     

青少年病态肥胖腹腔镜袖状胃切除术的护理体会

总结23例青少年病态肥胖患者行腹腔镜袖状胃切除术的护理体会。护理重点为术前针对肥胖患者特点,给予特殊安排,并做好心理护理;术后加强出血观察,做好引流管护理和呼吸道的管理,完善饮食指导,术前、术后做好皮肤护理,以保证手术成功。23例患者均顺利恢复出院,无手术相关并发症。     

Laparoscopic sleeve gastrectomy: a guide to postoperative anatomy and complications

The purpose of this pictorial essay is to review the surgical technique, postoperative anatomy, and potential complications of the laparoscopic sleeve gastrectomy. As the laparoscopic sleeve gastrectomy becomes an increasingly popular bariatric surgery, it is important for radiologists to familiarize themselves with the procedure and possible complications.     

Early gastric cancer successfully treated by endoscopic submucosal resection 1 year after laparoscopic sleeve gastrectomy with duodenal‐jejunal bypass

This case involved a 64‐year‐old female patient with a BMI of 35.3 kg/m² and poorly controlled type 2 diabetes mellitus. Preoperative upper gastrointestinal endoscopy revealed chronic, atrophic gastritis. Helicobacter pylori antibody was negative. The patient underwent laparoscopic sleeve gastrectomy with duodenal‐jejunal bypass as a metabolic surgery to treat obesity and type 2 diabetes mellitus. At 1 year postoperatively, routine endoscopy detected a flat elevated lesion at the distal gastric sleeve, near the posterior wall of the antrum; biopsy revealed adenocarcinoma. Endoscopic submucosal resection was performed without complication. This case shows the advantage of laparoscopic sleeve gastrectomy with duodenal‐jejunal bypass in screening the excluded stomach as compared to laparoscopic Roux‐en‐Y gastric bypass. Therefore, laparoscopic sleeve gastrectomy with duodenal‐jejunal bypass can be a viable alternative to laparoscopic Roux‐en‐Y gastric bypass for regions where gastric cancer is endemic.     

Laparo-endoscopic single-site sleeve gastrectomy: results from a preliminary series of selected patients

Laparoscopic sleeve gastrectomy (LSG) has received recognition in the treatment of patients with morbid obesity and BMI <40 kg/m2 and high-risk patients with BMI >50 kg/m2. Conventional LSG usually requires the placement of four or more trocars. Recently, newly designed access devices have allowed a single-incision laparoscopic approach; however, the clinical application of this method is still limited. We describe the operative steps of laparo-endoscopic single-site (LESS) sleeve gastrectomy and report the preliminary results: in 12 selected patients. The functional results did not differ significantly from those of standard LSG, with a median excess weight loss of 79% twelve months after surgery. Furthermore, cosmetic results seemed to be improved and postoperative pain reduced compared to standard LSG.     

History and current status of bariatric and metabolic surgeries in East Asia

Morbid obesity and obesity‐related comorbidities are major public health problems around the world, including in East Asia. Although Asian populations have been shown to have an elevated risk of type 2 diabetes mellitus, hypertension, and hyperlipidemia at a relatively lower BMI than Western populations, the Asian perspective on bariatric and metabolic surgeries has not been actively discussed until recently. Bariatric surgery in East Asia has undergone a paradigm shift since the first laparoscopic vertical bariatric surgery was performed in Taiwan in 1998, which was subsequently followed by the introduction of laparoscopic adjustable gastric banding, Roux‐en‐Y gastric bypass, and mini‐gastric bypass. Since 2006, use of laparoscopic sleeve gastrectomy has remarkably increased because of its ease, speed, and safety. With regard to metabolic surgery, a randomized controlled trial in Taiwan demonstrated that laparoscopic Roux‐en‐Y gastric bypass is more effective than laparoscopic sleeve gastrectomy for surgical treatment of poorly controlled type 2 diabetes mellitus and metabolic syndrome. In this article, we describe the history of bariatric procedures, revision surgeries, weight‐loss effect, and metabolic surgeries in Asian populations, and we also discuss minimally invasive bariatric surgery with some important citations.     

La plicature gastrique verticale (PGV) : serait-elle le futur Sleeve-killer ?

Gastric plication is a new surgical procedure in morbid obesity treatment, that achieves the same effect as sleeve gastrectomy, gastric trans-section and resection being replaced by a running suture of the gastric greater curve, that is hence preserved. The complication rate does not seem to exceed 1%. Published results in terms of weight-loss are encouraging (55% of excess weight-loss at 4 years) and seem to match the results of the sleeve gastrectomy, which can make it a valuable competitor.     

Laparo-endoscopic single-site sleeve gastrectomy: Results from a preliminary series of selected patients

Abstract

Laparoscopic sleeve gastrectomy (LSG) has received recognition in the treatment of patients with morbid obesity and BMI <40 kg/m² and high-risk patients with BMI >50 kg/m². Conventional LSG usually requires the placement of four or more trocars. Recently, newly designed access devices have allowed a single-incision laparoscopic approach; however, the clinical application of this method is still limited. We describe the operative steps of laparo-endoscopic single-site (LESS) sleeve gastrectomy and report the preliminary results: in 12 selected patients. The functional results did not differ significantly from those of standard LSG, with a median excess weight loss of 79% twelve months after surgery. Furthermore, cosmetic results seemed to be improved and postoperative pain reduced compared to standard LSG.     

Wernicke's Encephalopathy after Sleeve Gastrectomy for Morbid Obesity - A Case Report -

Morbid obesity is a curable systemic disease that can cause several complications, including hypertension, diabetes mellitus, and osteoarthritis. However, it is not easy to control solely by conservative management. Bariatric surgeries, such as sleeve gastrectomy and gastric banding, are recently developed treatments that are applied to patients with morbid obesity in Korea. However, gastric surgery can cause surgical or metabolic complications, such as thiamine deficiency, which can lead to Wernicke's encephalopathy. This metabolic complication presents with typical symptoms of confusion, ophthalmoplegia, nystagmus, and ataxia. In this case report, we present a case of Wernicke's encephalopathy, which developed slowly following sleeve gastrectomy in a patient with morbid obesity.     

Surgical management of super-super obesity with grade III esophageal varices and liver cirrhosis: The ultimate challenge

The risk of complications after bariatric surgery is high in morbidly obese patients suffering from liver cirrhosis along with moderate to severe portal hypertension. Esophageal varices are even considered as a contraindication for bariatric surgery by many surgeons. We report the case of a 40-year-old gentleman with a body mass index of 65.3 kg/m², with multiple comorbidities including type 2 diabetes mellitus, severe obstructive sleep apnea. On evaluation, he had Child-Pugh A liver cirrhosis with portal hypertension along with grade III esophageal varices and splenomegaly. After adequate optimization, laparoscopic sleeve gastrectomy was performed. The patient is doing well at a follow up of 12 months with an adequate weight loss and resolution of comorbidities. Sleeve gastrectomy can be performed in a morbidly obese Child-Pugh A cirrhotic patient with portal hypertension and esophageal varices with proper counseling regarding more than usual risk for morbidity and mortality.     

Outcomes and complications after bariatric surgery

OVERVIEW: Bariatric surgery is an effective and increasingly common treatment for obesity and obesity-related comorbidities. There are currently two major categories of such surgery, grouped according to the predominant mechanism of action: restrictive procedures, such as vertical banded gastroplasty and adjustable gastric banding; and malabsorptive procedures with a restrictive component, such as Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. In general, the more complex the procedure, the better the results in terms of weight loss; but there's evidence that more complex procedures also have higher morbidity and mortality rates. This article outlines five of the most common procedures, discusses the outcomes and complications of bariatric surgery, and describes the nursing implications for pre- and postoperative patient care.     

Reduced port laparoscopic gastrectomy: A review,techniques, and perspective

Reduced port laparoscopic surgery has been used increasingly. It is a concept that has grown out of the various efforts aimed at minimally invasive surgery, with SILS being the ultimate reduced port technique. Reduced port laparoscopic surgery has been used to perform sleeve gastrectomy in bariatric surgery and excision of benign gastric submucosal tumor, applications that generally do not require lymph node dissection or complicated reconstruction. It can be done safely, result in a permanent cure, and offer good cosmetic outcomes. Reduced port laparoscopic surgery for gastric cancer has a short history, and its usefulness has not yet been fully established. This review describes the present situation and challenges faced as well as standardized procedures and the future prospects of reduced port laparoscopic gastrectomy for gastric cancer, which my team performs almost daily. These aspects of reduced port laparoscopic surgery are presented in light of the literature.