切换至 "中华医学电子期刊资源库"

中华肥胖与代谢病电子杂志 ›› 2024, Vol. 10 ›› Issue (04) : 261 -268. doi: 10.3877/cma.j.issn.2095-9605.2024.04.006

青年专家论坛

减重与代谢外科肝脏悬吊方式研究进展
孙伟1, 徐东升2,()   
  1. 1.150010 哈尔滨,哈尔滨市第一医院普外科
    2.150010 哈尔滨,哈尔滨市第一医院肥胖病与代谢病多学科诊疗中心
  • 收稿日期:2024-05-22 出版日期:2024-11-30
  • 通信作者: 徐东升
  • 基金资助:
    黑龙江省卫生健康委科研课题(20220404010682)

Advances in weight loss and liver retraction in metabolic and bariatric surgery

Wei Sun1, Dongsheng Xu2,()   

  1. 1.Department of General Surgery,Harbin First Hospital, Harbin 150010, China
    2.Obesity and metabolic disease multidisciplinary treatment center, Harbin First Hospital, Harbin 150010, China
  • Received:2024-05-22 Published:2024-11-30
  • Corresponding author: Dongsheng Xu
引用本文:

孙伟, 徐东升. 减重与代谢外科肝脏悬吊方式研究进展[J/OL]. 中华肥胖与代谢病电子杂志, 2024, 10(04): 261-268.

Wei Sun, Dongsheng Xu. Advances in weight loss and liver retraction in metabolic and bariatric surgery[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2024, 10(04): 261-268.

减重代谢手术是目前治疗病态肥胖和2型糖尿病最有效的方法。如何安全有效地悬吊肝脏组织,是推进手术进程的关键。本文对近年来减重代谢手术各类肝脏悬吊方式的选择及应用进行阐述,分析其术野暴露、肝功能影响、出血程度、疼痛程度、操作难易度等,比较不同方法的优点和缺点。旨在为减重代谢手术领域的研究者和临床医生提供有益的参考。

Metabolic and bariatric surgery is currently the most effective treatment for morbid obesity and type 2 diabetes.How to retract liver tissue safely and effectively is the key to promote the surgical process.In this paper, the selection and application of various liver retraction methods in weightloss metabolic surgery in recent years are described.Their surgical field exposure, liver function influence,bleeding degree, pain degree, and difficulty of operation are analyzed, and the advantages and disadvantages of different methods are compared.The aim is to provide a valuable reference for researchers and clinicians in metabolic and bariatric surgery.

图1 Nathanson牵开器(引自参考文献7)
图2 克氏针牵开器(引自参考文献8)
图3 Teleflex牵开器(引自参考文献9)
图4 L型牵开器(引自参考文献10)
图5 LiVac牵开器(引自参考文献12)
图6 T型牵开器(引自参考文献13)
图7 磁性牵开器(引自参考文献17)
图8 LiVac Sling牵开器(引自参考文献19)
图9 Bulldog牵开器(引自参考文献20)
图10 弹性体内牵开器(引自参考文献21)
图11 医用胶牵开器(引自参考文献22)
图12 缝线牵开器(引自参考文献27)
[1]
Jensen DM, Ryan HD, Apovian MC, et al.2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults [J].Journal of the American College of Cardiology, 2014, 63(25): 2985-3023.
[2]
Ta'ani AO, Ajlouni AAY, Aleyadeh W, et al.The impact of overweight and obesity on health outcomes in the United States from 1990 to 2021 [J].Diabetes, obesity & metabolism, 2024, 26(11): 5455-5465.
[3]
Gojayev A, Yüksel C, Mercan Ü, et al.The effect and clinical significance of using nathanson liver retractor on liver function tests in laparoscopic gastric cancer surgery [J].Polish Journal of Surgery,2021, 94(1): 54-61.
[4]
Orr K,Williams M.MDCT of retractor-related hepatic injury following laparoscopic surgery: Appearances, incidence, and followup [J].Clinical Radiology, 2014, 69(6): 606-610.
[5]
Midya S, Ramus J, Hakim A, et al.Comparison of two types of liver retractors in laparoscopic Roux-en-Y gastric bypass for morbid obesity [J].Obesity Surgery, 2020, 30(1): 233-237.
[6]
Kitajima T, Shinohara H, Haruta S, et al.Prevention of transient liver damageafter laparoscopic gastrectomy via modification of the liver retraction technique using the N athanson liver retractor [J].Asian Journal of Endoscopic Surgery, 2015, 8(4): 413-418.
[7]
Soneda W, Booka E, Haneda R, et al.A silicone disc for liver retraction in laparoscopic gastrectomy reduces the postoperative increase in the liver enzyme level [J].Surgery Today, 2024, 54(10):1-11.
[8]
Zheng X, Sang Q, Wang L, et al.K-wire retractor, a trocar-free liver retraction technique in bariatric surgery [J].Obesity Surgery, 2021,31: 1113-1119.
[9]
Ahmad A, Arellano JJ, Agarwala A, et al.A percutaneous technique of liver retraction in laparoscopic bariatric & upper abdominal surgery [J].Surgery for Obesity and Related Diseases, 2016, 12(8): 1626-1629.
[10]
Hatao F, Imamura K, Ishibashi Y, et al.Liver retraction using an L-shaped retractor during sleeve gastrectomy [J].Surgery Today,2022, 52(4): 574-579.
[11]
Gan P, Bingham J.A clinical study of the LiVac laparoscopic liver retractor system [J].Surgical endoscopy, 2016, 30(2): 789-796.
[12]
Park D, Kim YJ, Chung Y.Laparoscopic sleeve gastrectomy using the LiVac liver retractor system: technical report [J].Annals of surgical treatment and research, 2021, 101(1): 65-67.
[13]
Zachariah SK, Tai CM, Chang PC, et al.The “T-suspension tape”for liver and gallbladder retraction in bariatric surgery: feasibility,technique, and initial experience [J].Journal of Laparoendoscopic &Advanced Surgical Techniques, 2013, 23(4): 311-315.
[14]
Huang CK, Tsai JC, Lo CH, et al.Preliminary surgical results of single-incision transumbilical laparoscopic bariatric surgery [J].Obesity surgery, 2011(3), 21: 391-396.
[15]
Borjas G, Sanchez N, Urdaneta A, et al.Technical aspects of using a second magnetic grasper to improve the surgical field in single port revisional bariatric surgery [J].Obesity Surgery, 2023, 33(3): 984-985.
[16]
Luengas R, Galindo J, Castro M, et al.First prospective clinical trial of reduced incision bariatric procedures using magnetic liver retraction [J].Surgery for Obesity and Related Diseases, 2021, 17(1):147-152.
[17]
Welsh LK, Davalos G, Diaz R, et al.Magnetic liver retraction decreases postoperative pain and length of stay in bariatric surgery compared to Nathanson device [J].Journal of Laparoendoscopic &Advanced Surgical Techniques, 2021, 31(2): 194-202.
[18]
Borjas G, Urdaneta A, Ramos E, et al.Magnetic liver retraction in bariatric surgery: Is it possible? [J].Cirugía Española, 2024, 102(6):331-334.
[19]
Bures C, Seika P, Fiorelli RAK, et al.Novel trocar-free elastic liver retractor in bariatric surgery patients: Comparison of a standard laparoscopic retraction with the first series using the LiVac Sling system [J].Surgical innovation, 2020, 27(2): 187-192.
[20]
Sweeny A, Buglino L, La Vella E, et al.Comparison of a novel,trocar-free internal liver retractor to standard liver retraction in bariatric surgery [J].Obesity Surgery, 2019, 29(9): 3071-3075.
[21]
Mouawad C, Andraos Y, Sleilati F.Elastic intra-corporeal retractor for bariatric and upper gastrointestinal surgery [J].Obesity Surgery, 2024,34(7): 1-6.
[22]
Wu S, Yu H, Fan Y, et al.Liver retraction using n-butyl-2-cyanoacrylate glue during single-incision laparoscopic upper abdominal surgery [J].Journal of British Surgery, 2014, 101(5): 546-549.
[23]
Aldeghaither S, Tang B, Alijani A, et al.Liver retraction system by C3-muco-adhesive polymer films for laparoscopic surgery [J].Surgical endoscopy, 2016, 30: 2834-2839.
[24]
吴硕东, 姚殿波, 孙余田.肝左外叶粘贴式悬吊在单孔腹腔镜左季肋区手术中的应用价值 [J].中华消化外科杂志, 2018, 17(5): 497-501.
[25]
田利飞, 李泽雨, 赵旭, 等.两种肝悬吊方法在腹腔镜胃癌根治术中应用的对比研究 [J].中华普通外科杂志, 2021, 36(4): 263-266.
[26]
Cal P, Deluca L, Jakob T, et al.Low-cost incisionless liver retraction for laparoscopic sleeve gastrectomy: a prospective controlled trial [J].Journal of Laparoendoscopic & Advanced Surgical Techniques, 2019,29(12): 1556-1560.
[27]
De la Torre R, Scott JS, Cole E.A suture-based liver retraction method for laparoscopic bariatric procedures: results from a large case series[J].Surgery for Obesity and Related Diseases, 2015, 11(6): 1377-1382.
[28]
Takemura M, Ikebe T, Mayumi K, et al.A novel liver retraction technique for lateral lobe of the liver during laparoscopic surgery using silicone disk [J].Journal of Laparoendoscopic & Advanced Surgical Techniques, 2011, 21(8): 729-732.
[29]
Saeki H, Oki E, Kawano H, et al.Newly developed liver-retraction method for laparoscopic gastric surgery using a silicone disc: the φ-shaped technique [J].Journal of the American College of Surgeons,2013, 216(5): e43-e46.
[30]
Wang CJ, Chao YJ, Sy ED, et al.A simple method of intracorporeal"W-shaped" liver retraction technique for minimally invasive gastric cancer surgery [J].Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2019, 29(3): e24-e28.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[11] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[12] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要