腹腔镜胃后、结肠后路胃空肠Roux—en—Y吻合术治疗单纯性肥胖症22例

目的探讨腹腔镜胃旁路手术方式中，胃后路胃空肠吻合手术方式的可行性和临床价值。方法2010年12月～2012年3月，对体重指数（BMI）≥35．0的单纯性肥胖症病例行结肠后腹腔镜胃空肠Roux—en—Y吻合术，随意分组，胃后路径22例，胃前路径38例。对比2组手术时间、出血量、术后住院时间、术后近期并发症发生率，术后6个月体重、BMI、多余体重减除率（EWL％）的差异。结果胃后路组手术时间较胃前路组长（157．2±9．2）minVS．（144．9±12．1）min，t=-4．127，P=0．000]；2组术中出血量，术后住院时间，术后6个月体重、BMI、EWL％差异均无显著性。胃前路组8例（21％）术后出现呕吐等上消化道不全梗阻症状，均在1周内缓解；胃后路组未出现类似并发症（P=0．022）。结论胃后路腹腔镜胃旁路手术是一种可行的术式，相比胃前路术式更符合生理，术后胃肠道近期并发症较少，胃肠道功能恢复较快。

Retro-gastric Laparoscopic Gastric Roux-en-Y Bypass for Simple Obesity:Report of 22 Cases

Objective To explore the feasibility and value of retro-gastric gastrojejunal anastomosis after laparoscopic gastric Roux-en-Y bypass. Methods A retrospective analysis on totally 60 patients with a simple obesity （ BMI /〉 35.0） , who underwent retro-gastric gastrojejunal anastomosis after laparoscopic gastric Roux-en-Y bypass in our hospital from December 2010 to March 2012. The patients were divided into two groups to receive retro （22 cases） and ante-gastric （38 cases） approaches respectively. The operation time, intraoperative blood loss, postoperative hospital stay and short-term rate of complications, as well as the weight and EWL% in 6 months after the procedure were compared between the two groups. Results The retro-gastric group showed significantly longer operation time than anti-gastric group （ 157.2 ± 9.2） min vs. （ 144.9± 12.1 ） min, t = - 4. 127, P = 0. 000 ]. No significant difference was detected in the intraoperative blood loss, postoperative hospital stay and the weight and EWL% in 6 months after the procedure between the two groups. In the ante-gastric group, 8 patients （21%） had vomit and other symptoms of incomplete obstruction of the upper digestive tract, which were all cured in one week; whereas, no such complications occurred in retro-gastric group （P = 0. 022）. Conclusion Retro-gastric laparoscopic gastric Roux-en-Y bypass is feasible, and better suits the patients ＇ physiological conditions than ante-gastric approach, and thus leads to less complications and quick recovery of gastrointestinal function.