您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2026, Vol. 64 ›› Issue (7): 63-68.doi: 10.6040/j.issn.1671-7554.0.2024.1429

• 临床医学 • 上一篇    下一篇

腹腔镜袖状胃切除术中大网膜复位对术后恶心呕吐影响

王远,张晶,丁印鲁   

  1. 山东大学齐鲁第二医院胃肠外科, 山东 济南 250033
  • 出版日期:2026-07-10 发布日期:2026-07-21
  • 通讯作者: 丁印鲁. E-mail:dingyinlu@126.com

Effect of retropositioning of the large omentum in laparoscopic sleeve gastrectomy for postoperative nausea and vomiting

WANG Yuan, ZHANG Jing, DING Yinlu   

  1. Department of Gastrointestinal, The Second Qilu Hospital of Shandong University, Jinan 250033, Shandong, China
  • Online:2026-07-10 Published:2026-07-21

PDF (PC)

1

摘要： 目的 探讨腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy, LSG)中大网膜复位对减少术后恶心呕吐(postoperative nausea and vomiting, PONV)的影响。 方法 采取回顾性队列研究的方法,收集2023年1月至2024年1月在山东大学齐鲁第二医院胃肠外科接受LSG的62例肥胖症患者围手术期临床资料。其中,30例患者行LSG大网膜复位(大网膜复位组),32例患者仅进行缝合加固胃切缘(对照组)。收集两组患者的术前基线资料、围手术期资料,比较患者术后PONV的频率评分、视觉模拟评分(visual analogue scale, VAS)、语言描述评分(verbal descriptive scale, VDS)。 结果 两组患者的手术时间、加固缝合时间、术中出血量差异无统计学意义(P>0.05)。在术后0~12、12~24及24~72 h内,大网膜复位组患者的PONV的频数评分、VAS评分、VDS评分都优于对照组(P<0.05)。 结论 LSG中大网膜复位可降低患者PONV的发生率及严重程度。

关键词: 腹腔镜, 袖状胃切除术, 术后恶心呕吐, 肥胖症, 大网膜复位

Abstract: Objective To explore the impact of greater omentum repositioning after laparoscopic sleeve gastrectomy(LSG)on reducing postoperative nausea and vomiting(PONV). Methods A retrospective cohort study was conducted to collect the perioperative clinical data of 62 obese patients who underwent LSG in the Department of Gastrointestinal Surgery, The Second Qilu Hospital of Shandong University from January 2023 to January 2024. Among them, 30 patients underwent greater omentum repositioning after LSG(reduction group), and 32 patients only had the gastric incisions sutured and reinforced(control group). The preoperative baseline data and perioperative data of the patients were collected. The frequency scores of PONV, visual analogue scale(VAS)scores, and verbal descriptive scale(VDS)scores between the two groups of patients postoperatively were compared. Results There was no statistically significant differences in surgical duration, reinforcement suture time, and intraoperative blood loss between the two groups(P>0.05). Within 0-12 hours, 12-24 hours, and 24-72 hours after surgery, the frequency score, VAS score, and VDS score of PONV in the reduction group were higher than those in the control group(P>0.05). Conclusion Reduction of the greater omentum during LSG may decrease the occurrence and intensity of PONV in patients.

Key words: Laparoscopic, Sleeve gastrectomy, Postoperative nausea and vomiting, Obesity, Retropositioning of the large omentum

中图分类号: 

  • R656.6
[1] 王亮, 陈禧媛, 张能维. 肥胖合并2型糖尿病外科治疗研究进展[J]. 中华普通外科杂志, 2024, 39(4): 246-251. Wang Liang, Chen Xiyuan, Zhang Nengwei. Advances in surgical treatment of obesity complicated with type 2 diabetes mellitus[J]. Chinese Journal of General Surgery, 2024, 39(4): 246-251.
[2] 刘阳, 陈宇涵, 周福庆, 等. 肥胖代谢外科2024年发展热点[J]. 中华普通外科杂志, 2025, 40(4): 241-245. Liu Yang, Chen Yuhan, Zhou Fuqing, et al. Hot topics in obesity and metabolic surgery in 2024[J]. Chinese Journal of General Surgery, 2025, 40(4): 241-245.
[3] 李梦伊, 刘雁军, 王桂琦, 等. 大中华减重与代谢手术数据库2023年度报告[J]. 中国实用外科杂志, 2024, 44(5): 552-563. Li Mengyi, Liu Yanjun, Wang Guiqi, et al. Greater China metabolic and bariatric surgery database registry report(2023)[J]. Chinese Journal of Practical Surgery, 2024, 44(5): 552-563.
[4] Yang L, Xu Y J, Shen J, et al. Propofol-based total intravenous anesthesia decreases the incidence of postoperative nausea and vomiting without affecting flap survival in free flap breast reconstruction[J]. Gland Surg, 2020, 9(5): 1406-1414.
[5] Xue Q, Xing Q J, Dong L, et al. ST36 acupoint injection with anisodamine for postoperative nausea and vomiting in female patients after bariatric surgery: a prospective, randomized controlled trial[J]. Surg Endosc, 2023, 37(8): 5999-6007.
[6] 李思源, 魏时靖, 孙莉, 等. 全身麻醉术后恶心呕吐危险因素及现有止吐药物效果的回顾性研究分析[J]. 中国临床医生杂志, 2023, 51(2): 228-232.
[7] Qin J Z, Ye X X, Ye C Z, et al. The effect of transcutaneous electrical acupoint stimulation on high-risk patients with PONV undergoing laparoscopic gynecologic surgery: a randomized controlled trial[J]. J Clin Med, 2023, 12(3): 1192. DOI:10.3390/jcm12031192
[8] Ao Y C, Ma J Y, Zheng X Z, et al. Opioid-sparing anesthesia versus opioid-free anesthesia for the prevention of postoperative nausea and vomiting after laparoscopic bariatric surgery: a systematic review and network meta-analysis[J]. Anesth Analg, 2025, 140(2): 385-396.
[9] 王东昕, 杨希革, 赵恒兰, 等. CO2气腹对腹腔镜手术患者血清胃动素浓度的影响[J]. 中华麻醉学杂志, 2008, 28(5): 437-439. Wang Dongxin, Yang Xige, Zhao Henglan, et al. Effects of CO2 pneumoperitoneum on serum concentration of motilin in patients undergoing laparoscopic cholecystectomy[J]. Chinese Journal of Anesthesiology, 2008, 28(5): 437-439.
[10] 胡江, 李龙艳, 彭云水, 等. 术后恶心呕吐诊疗指南(2024版)计划书[J]. 中华麻醉学杂志, 2025, 45(4): 405-409. Hu Jiang, Li Longyan, Peng Yunshui, et al. Protocol for clinical practice guidelines on postoperative nausea and vomiting(2024 edition)[J]. Chinese Journal of Anesthesiology, 2025, 45(4): 405-409.
[11] 田志帅, 贾明洋, 陈帅帅, 等. 加速康复外科对腹腔镜袖状胃切除术后恶心呕吐的影响[J]. 中国现代普通外科进展, 2024, 27(11): 899-902.
[12] 刘华江, 杨华, 姜舒文, 等. 腹腔镜袖状胃切除术中大网膜复位的应用及效果[J]. 中华肥胖与代谢病电子杂志, 2018, 4(3): 146-150. Liu Huajiang, Yang Hua, Jiang Shuwen, et al. Application and outcomes of omentum reposition during laparoscopic sleeve gastrectomy[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2018, 4(3): 146-150.
[13] Abdallah E, Zakaria M, Fikry M, et al. Laparoscopic sleeve gastrectomy with T-shaped omentoplasty: impact on the early postoperative outcomes[J]. Obes Surg, 2020, 30(10): 3735-3741.
[14] Afaneh C, Costa R, Pomp A, et al. A prospective randomized controlled trial assessing the efficacy of omentopexy during laparoscopic sleeve gastrectomy in reducing postoperative gastrointestinal symptoms[J]. Surg Endosc, 2015, 29(1): 41-47.
[15] 中国研究型医院学会糖尿病与肥胖外科专业委员会. 减重与代谢外科加速康复外科原则中国专家共识(2021版)[J]. 中华肥胖与代谢病电子杂志, 2021, 7(3): 141-145. Chinese Society of Diabetes and Bariatric Surgery, Chinese Research Hospital Association. Chinese expert consensus on enhanced recovery after surgery principles in bariatric and metabolic surgery(2021 edition)[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 7(3): 141-145.
[16] 中国人体健康科技促进会肥胖糖尿病主动健康专业委员会. 中国对称三孔法腹腔镜胃袖状切除术规范化手术操作指南(2023版)[J]. 华西医学, 2023, 38(12): 1785-1791. Obesity and Diabetes Active Health Professional Committee of China Association for Promotion of Heath. Chinese standardized surgical guideline for symmetrical three-port laparoscopic sleeve gastrectomy(2023 edition)[J]. West China Medical Journal, 2023, 38(12): 1785-1791.
[17] 中国研究型医院学会糖尿病与肥胖外科专业委员会. 腹腔镜胃袖状切除术后恶心呕吐预防与处理中国专家共识(2022版)[J]. 中华消化外科杂志, 2022, 21(11): 1395-1402. Chinese Society of Diabetes and Bariatric Surgery, Chinese Research Hospital Association. Chinese expert consensus on the prevention and treatment of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy(2022 edition)[J]. Chinese Journal of Digestive Surgery, 2022, 21(11): 1395-1402.
[18] Halliday T A, Sundqvist J, Hultin M, et al. Post-operative nausea and vomiting in bariatric surgery patients: an observational study[J]. Acta Anaesthesiol Scand, 2017, 61(5): 471-479.
[19] Zhu J, Wu L N, Chen G J, et al. Preoperative reflux or regurgitation symptoms are independent predictors of postoperative nausea and vomiting(PONV)in patients undergoing bariatric surgery: a propensity score matching analysis[J]. Obes Surg, 2022, 32(3): 819-828.
[20] Fathy M, Abdel-Razik M A, Elshobaky A, et al. Impact of pyloric injection of magnesium sulfate-lidocaine mixture on postoperative nausea and vomiting after laparoscopic sleeve gastrectomy: a randomized-controlled trial[J]. Obes Surg, 2019, 29(5): 1614-1623.
[21] Nocca D, Picot M C, Donici I, et al. Evaluating the impact of the antrum size following laparoscopic sleeve gastrectomy: a randomized multicenter study[J]. Surg Obes Relat Dis, 2020, 16(11): 1731-1736.
[22] Avlanmis O, Isil R G, Burcu B. Effect of resection distance from pylorus on weight loss outcomes in laparoscopic sleeve gastrectomy[J]. Obes Surg, 2019, 29(9): 2731-2738.
[23] Kim J H, Kim J S, Jeon Y G, et al. Effect of dexa-methasone and ramosetron on the prevention of postoperative nausea and vomiting in low-risk patients: a randomized, double-blind, placebo-controlled, multicenter trial[J]. BMC Anesthesiol, 2023, 23(1): 363. DOI:10.1186/s12871-023-02334-3
[24] 赵雷, 陈昕, 杨亚利. 不同CO2气腹压力对患者血清P物质浓度的影响[J]. 中国实验诊断学, 2012, 16(5): 815-817. Zhao Lei, Chen Xin, Yang Yali. Effects of different CO2 pneumoperitoneum pressure on serum concentration of substance P in patients undergoing laparoscopic resection of rectal cancer[J]. Chinese Journal of Laboratory Diagnosis, 2012, 16(5): 815-817.
[25] Zhou C M, Wang Y, Xue Q, et al. Predicting early postoperative PONV using multiple machine-learning- and deep-learning-algorithms[J]. BMC Med Res Methodol, 2023, 23(1): 133. DOI:10.1186/s12874-023-01955-z
[26] 马俊丽, 魏新川. 术后恶心呕吐病因、 机制和治疗进展[J]. 实用医院临床杂志, 2022, 19(1): 190-193. Ma Junli, Wei Xinchuan. Etiology, mechanism and treatment progress of postoperative nausea and vomiting[J]. Practical Journal of Clinical Medicine, 2022, 19(1): 190-193.
[27] Ding X H, Zhu X Z, Zhao C M, et al. Use of sugammadex is associated with reduced incidence and severity of postoperative nausea and vomiting in adult patients with obesity undergoing laparoscopic bariatric surgery: a post-hoc analysis[J]. BMC Anesthesiol, 2023, 23(1): 163. DOI:10.1186/s12871-023-02123-y
[28] 尹慧, 胡有力. 胸腔内迷走神经阻滞对肺叶切除术患者术后恶心呕吐的影响[J]. 临床麻醉学杂志, 2024, 40(4): 384-388. Yin Hui, Hu Youli. Effect of intrathoracic vagus nerve block on postoperative nausea and vomiting in patients undergoing lobectomy[J]. Journal of Clinical Anesthe-siology, 2024, 40(4): 384-388.
[1] 梁振,闫晓东,马冬梅,朱琳. 基于CUSUM分析的腹腔镜宫颈癌根治术学习曲线与围手术期并发症的回顾性分析[J]. 山东大学学报 (医学版), 2026, 64(7): 35-41.
[2] 王刚,徐鹏演,赵旭安,王海锋,葛苗苗,潘华峰,江志伟. ω-3多不饱和脂肪酸对腹腔镜结直肠癌术后迷走神经和肠功能恢复的影响[J]. 山东大学学报 (医学版), 2025, 63(2): 36-42.
[3] 薛莹,周兴国,王宇,王德海,丁印鲁. 左侧巨大十二指肠旁疝1例报道[J]. 山东大学学报 (医学版), 2022, 60(8): 127-129.
[4] 李博,刘竞芳,鲍金鹏,李祥泽,秦广洋,田虎. 三维可视化联合吲哚菁绿荧光影像技术在51例原发性肝癌腹腔镜切除术中的应用价值[J]. 山东大学学报 (医学版), 2022, 60(3): 83-88.
[5] 秦虹,张士松,胡元军. 经脐单部位双通道腹腔镜手术治疗38例小儿急性阑尾炎[J]. 山东大学学报 (医学版), 2022, 60(12): 77-81.
[6] 仲明惟,胡三元. 我国腹腔镜技术治疗肥胖症手术方式的探索[J]. 山东大学学报 (医学版), 2021, 59(9): 72-77.
[7] 王璐,赵新蕊,朱琳. 25例早期宫颈癌无瘤化免举宫腹腔镜子宫切除术临床效果[J]. 山东大学学报 (医学版), 2021, 59(6): 76-80.
[8] 霍素霞,刘薇,王鑫. 86例Ⅲ型瘢痕妊娠诊治体会[J]. 山东大学学报 (医学版), 2021, 59(1): 40-44.
[9] 李涵,付婷婷,张磊,延冰,孙涛,郭峰,尹晓. 过氧化物酶增殖物激活受体γ激动剂对24例肥胖症患者米色脂肪细胞分化的影响[J]. 山东大学学报 (医学版), 2020, 1(9): 8-13.
[10] 刘超,闫动,李香,张蕾,李燕. 腹腔镜辅助经脐小切口治疗小儿美克尔憩室的临床分析[J]. 山东大学学报 (医学版), 2020, 1(9): 40-44.
[11] 张召义,韩婷,孙艳萍,李波. 聚乙二醇电解质散在40例妇科腹腔镜术前肠道准备中的应用[J]. 山东大学学报 (医学版), 2020, 58(2): 49-53.
[12] 王波,熊颖,倪志福,屈振繁. 加速康复外科理念在1~3岁日间疝手术中的应用[J]. 山东大学学报 (医学版), 2020, 58(12): 92-96.
[13] 张照鹏,邢乃栋,张翔,阎磊,徐忠华. 160例腹腔镜根治性膀胱切除术后淋巴漏的影响因素分析[J]. 山东大学学报 (医学版), 2020, 58(1): 67-72.
[14] 董昌正,周伟,李风周,臧义丰,丁印鲁. 全腹腔镜下全胃+胆囊+阑尾切除经自然腔道取标本手术1例[J]. 山东大学学报 (医学版), 2019, 57(7): 122-124.
[15] 华克勤,李珺玮,陈义松. 单孔腹腔镜在盆底功能障碍中的应用[J]. 山东大学学报 (医学版), 2019, 57(12): 10-14.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发