[Effects of sleeve gastrectomy base on "membrane anatomy" concept on postoperative nausea and vomiting in patients with obesity or metabolic diseases]

Objective: To explore the effects of the application of membrane anatomy concept in sleeve gastrectomy on postoperative nausea and vomiting (PONV) in patients with obesity or metabolic diseases. Methods: A retrospective cohort study was conducted. Clinical data of 88 patients with obesity or metabolic diseases who underwent laparoscopic sleeve gastrectomy in The First Affiliated Hospital of Jinan University from September 2018 to June 2019 were retrospectively analyzed. Forty patients underwent sleeve gastrectomy with membrane anatomy concept as membrane anatomy group, and the other 48 patients underwent traditional sleeve gastrectomy as traditional operation group. There were no significant differences in baseline data between the two groups (all P>0.05). The PONV score of and the times of antiemetic drugs used during 0-6 h and 6-24 h after operation were compared between the two groups. Higher PONV represents more serious nause and vomiting, the score ≥5 is defined as clinical significant PONV. Results: All patients of the two groups successfully completed the operation, and there was no conversion to open, reoperation, and operation-related death. The intraoperative blood loss in the membrane anatomy group was significantly less than that in the traditional surgery group [median: 5.0 (5.0, 5.8) ml vs. 10.0 (5.0, 10.0) ml, Z=-3.265, P=0.001]. There were no significant differences between the two groups in terms of operative time, postoperative hospital stay, gastroesophageal reflux, pain score and postoperative complications (all P>0.05). There was no postoperative bleeding or gastric leakage in either groups. There were no significant differences in PONV score, incidence of clinically significant PONV and use of antiemetics 0-6 h after operation between two groups (all P>0.05). From 6 to 24 hours after operation, compared with traditional surgery group, the membrane anatomy group had lower PONV score (4.6±0.9 vs. 5.1±0.7, t=-2.192, P=0.007), lower incidence of clinically significant PONV [55.0% (22/40) vs. 83.3% (40/48), χ(2)=8.414, P=0.004] and less use of antiemetics [3 times: 10.0% (4/40) vs. 27.1% (13/48), Z=-2.880, P=0.004]. Postoperative follow-up ranged from 1 to 6 months (median 3), 32 cases in membranous anatomy group and 38 cases in the traditional operation group were followed up. One case in the traditional operation group received symptomatic treatment in the local hospital due to functional intestinal obstruction 1 month after surgery and was discharged after recovery. The remaining patients had no postoperative complications and were not readmitted to hospital. Conclusion: Sleeve gastrectomy based on membrane anatomy in the treatment of patients with obesity or metabolic syndrome can make surgical procedure more precise and meticulous, reduce the intraoperative bleeding and the incidence of PONV.

目的： 袖状胃切除术后患者出现恶心呕吐（PONV）的发生率较高，而PONV的发生与手术技巧、切割及缝合方式等方面有关。本研究探讨膜解剖理念应用于袖状胃切除术对减少PONV发生率的影响。 方法： 采用回顾性队列研究方法。回顾性收集2018年9月至2019年6月期间，暨南大学附属第一医院收治的行腹腔镜袖状胃切除术的88例肥胖和代谢性疾病患者临床资料。其中40例患者采用膜解剖理念的袖状胃切除术（膜解剖手术组），48例采用传统袖状胃切除术（传统手术组）；两组患者基线资料的比较，差异均无统计学意义（均P>0.05）。比较两组患者围手术期情况、术后0~6 h及6~24 h PONV评分及止呕药使用次数等方面情况。PONV评价标准：采用PONV影响量表进行评分，评分越高，表示恶心呕吐越严重；评分≥5为临床显著PONV。 结果： 两组患者均顺利完成手术，无中转开腹、再手术、围手术期死亡的情况发生。膜解剖手术组术中出血量明显少于传统手术组，两组比较差异有统计学意义[中位数：5.0（5.0，5.8）ml比10.0（5.0，10.0）ml，Z=-3.265，P=0.001]；两组患者的手术时间、术后住院时间、胃食管反流及疼痛评分的差异均无统计学意义（均P>0.05）。两组患者均无术后出血、胃漏发生。两组患者术后0~6 h PONV评分和临床显著PONV发生率以及止呕药使用比例的比较，差异均无统计学意义（均P>0.05）。术后6~24 h，与传统手术组比较，膜解剖手术组的PONV评分[（4.6±0.9）分比（5.1±0.7）分，t=-2.192，P=0.007]和临床显著PONV发生率[55.0%（22/40）比83.3%（40/48），χ(2)=8.414，P=0.004]以及止呕药使用比例[3针比例：10.0%（4/40）比27.1%（13/48），Z=-2.880，P=0.004]均低，差异有统计学意义（均P<0.05）。术后随访1~6（中位数3）个月，膜解剖手术组和传统手术组分别有32例和38例完成了随访，除1例传统手术组患者术后1个月因功能性肠梗阻在当地医院行对症治疗后好转出院，其余患者无术后并发症再次入院治疗情况。 结论： 基于膜解剖理念的袖状胃切除术运用于治疗患者肥胖症或合并代谢综合征患者，手术操作更加精准细致，可减少术中出血量，降低PONV的发生率。.

Keywords: Membrane anatomy; Metabolic diseases; Obesity; Postoperative nausea and vomiting (PONV); Sleeve gastrectomy.