论文部分内容阅读
目的探讨3D高清腹腔镜技术在减重代谢手术中的应用价值。方法纳入笔者所在医院科室2015年1月至2017年5月期间接受减重代谢手术患者64例,采用随机对照双盲研究方法分成3D腹腔镜组和2D腹腔镜组,手术方式包括腹腔镜下胃旁路术及腹腔镜下袖状胃切除术,分析比较不同手术方式下的总手术时间、缝合操作时间、消化道重建时间、术中出血量、术后住院时间及术后并发症指标。结果 3D腹腔镜组32例,其中袖状胃切除术19例,胃旁路术13例;2D腹腔镜组32例,其中袖状胃切除术21例,胃旁路术11例。64例减重代谢手术均在腹腔镜下完成,无中转开腹手术者,并且3D腹腔镜组中无中转更改为2D腹腔镜情况发生。(1)2D和3D腹腔镜下袖状胃切除术治疗结果比较:在3D腹腔镜下的缝合胃切缘时间明显短于2D腹腔镜(P<0.05),术中出血量也少于2D腹腔镜(P<0.05);2种方式下的总手术时间及术后住院时间比较差异无统计学意义(P>0.05),均无胃漏等严重并发症发生。(2)2D和3D腹腔镜下胃旁路术治疗结果比较:在3D腹腔镜下的总手术时间、制作胃小囊时间、胃-空肠吻合和空肠-空肠吻合时间以及术中出血量均明显优于2D腹腔镜(P<0.05);2种方式下的术后住院时间比较差异无统计学意义(P>0.05)。结论从本研究中有限的数据初步得出,与2D腹腔镜比较,3D腹腔镜下清晰的三维立体视觉,使解剖层次更加清晰可辨,有助于减重代谢手术的精细操作,缩短手术时间,使医师和患者均能获益。
Objective To explore the value of 3D high-resolution laparoscopy in weight-loss metabolic surgery. Methods Sixty-four patients undergoing weight-loss metabolic surgery from January 2015 to May 2017 were included in the study. The patients were divided into 3D laparoscopic group and 2D laparoscopic group by randomized controlled double-blind study. The surgical methods included laparoscopic gastric Bypass operation and laparoscopic sleeve gastrectomy. The total operation time, suture operation time, gastrointestinal reconstruction time, intraoperative blood loss, postoperative hospital stay and postoperative complications were analyzed and compared under different operation methods. Results 32 cases of 3D laparoscopic group, including sleeve gastrectomy in 19 cases, gastric bypass surgery in 13 cases; 2D laparoscopic group of 32 cases, including sleeve gastrectomy in 21 cases, gastric bypass in 11 cases. Sixty-four cases of weight-loss metabolic surgery were performed under laparoscopy without any conversion to laparotomy, and no laparoscopy was performed in 3D laparoscopic group. (1) Comparing the results of 2D and 3D laparoscopic sleeve gastrectomy: The laparoscopic suturing time under 3D laparoscopy was significantly shorter than that of 2D laparoscopy (P <0.05), and the intraoperative blood loss was less than that of 2D abdominal cavity (P <0.05). There was no significant difference between the two methods in the total operation time and postoperative hospital stay (P> 0.05). No severe complications such as gastric lavage occurred. (2) Comparing the results of 2D and 3D laparoscopic gastric bypass surgery: The time of 3D laparoscopic operation, the time of making gastric sac, the time of gastro-jejunojejunostomy and jejunum-jejunum anastomosis, and the amount of intraoperative blood loss were all significant (P <0.05). There was no significant difference in postoperative hospital stay between the two methods (P> 0.05). Conclusions From the limited data in this study, we conclude that, compared with 2D laparoscopy, the 3D stereoscopic vision under 3D laparoscopy can make the anatomic level more clearly and clearly, which helps to fine-tune the operation of weight loss metabolism and shorten the operation time , So that both physicians and patients can benefit.