目的 探讨基于膜解剖指导下的胃左系膜、胃后系膜、胰腺系膜三三交汇处TJ点至左侧膈肌脚内侧缘顶点"两点一线"为解剖标志的胃底体一体化游离方式(two points and one line model,TPOL模型)腹腔镜袖状胃切除术(LSG)的可行性与安全性.方法 我院2019年1月～2022年1月收治的肥胖病或肥胖合并代谢综合征病人135例,均行LSG治疗.根据胃底体游离方式不同,分为两组,研究组68例,采用TPOL模型LSG手术.对照组67例,采用常规LSG手术.比较两组病人手术时间、胃底游离时间、术中出血量、住院时间、术后胃漏、出血、胃食管反流发生率等指标.结果 所有病人均顺利完成LSG手术,术后随访12～36个月.研究组与对照组手术时间分别为(56.13±10.56)分钟和(62.45±12.74)分钟,胃底游离时间分别为(6.34±4.16)分钟和(12.58±6.37)分钟,住院时间分别为(3.84±0.42)天和(4.06±0.69)天,术中出血量分别为(10.87±1.28)ml和(15.56±3.39)ml,术后胃食管反流发生率分别为5例(7.35％)和13例(19.40％),两组比较差异有统计学意义(P＜0.05).两组术后12个月多余体重减少以及术后出血、胃漏等并发症比较,差异无统计学意义(P＞0.05).结论 基于膜解剖指导下的胃后TJ点至左侧膈肌脚内侧缘顶点"两点一线"为解剖标志的胃底体一体化游离方式(TPOL模型)LSG术可高效、安全、完整游离胃底,对LSG的胃底规范化游离具有临床价值.
Laparoscopic sleeve gastrectomy based on two points and one line as anatomical landmark
Objective To investigate the viability and safety of laparoscopic sleeve gastrectomy(LSG)based on the TJ point at the junction of the posterior gastric wall and the apex of the medial edge of the left diaphragm.Methods A retrospective analysis of 135 patients with obesity or obesity with metabolic syndrome who underwent LSG from January 2019 to January 2022 were divided into two groups according to the different free modes of fundogastric body.68 patients underwent surgery using the TPOL model LSG.A control group of 67 patients was treated with conventional LSG surgery.To analyze and compare the duration of operation,gastric fundus free time,intraoperative blood loss time,hospital stay time,postoperative gastric fistula,bleeding rate,and occurrence of gastroesophageal reflux disease(GERD)between the two groups.Results All patients successfully completed LSG surgery and were safely discharged.They were followed for a period of 12 to 36 months.the duration of operation for the study group was(56.13±10.56)minutes,while for the control group it was(62.45±12.74)minutes.The gastric fundus was freed in(6.34±4.16)minutes for the study group and(12.58±6.37)minutes for the control group.The duration of hospitalization was(3.84±0.42)days for the study group and(4.06±0.69)days for the control group.The intraoperative blood loss was(10.87±1.28)ml for the study group and(15.56±3.39)ml for the control group.The incidence of postoperative GERD was 5(7.35％)for the study group and 13(19.40％)for the control group.The differences between the two groups were statistically significant(P＜0.05).The decrease in excess weight at 12 months after surgery,as well as complications such as bleeding and gastric fistula,were not statistically significant(P＞0.05).Conclusion LSG(TPOL model)extends from the TJ point(the Tri-junction point where the gastric left mesangium,gastric posterior mesangium,and pancreatic mesangium meet)to the apex of the medial foot edge of the left diaphragm.LSG(TPOL model)can be efficiently and safely achieve tension-free anastomosis,resulting in a complete free gastric fundus.This method is feasible,and has clinical value for the standardized free gastric fundus of LSG.
laparoscopy Sleeve gastrectomytwo points and one linetwo points and one line model modelanatomical landmark
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