本研究旨在比较单孔腹腔镜袖状胃切除术（LSG）与多孔LSG在术后短期减重效果、心理状态改善及患者切口满意度等方面的差异，探讨单孔LSG的临床优势及其潜在机制，为肥胖症患者的个体化手术方式选择提供科学依据。

回顾性分析2023年9月至2024年12月在上海市第六人民医院接受LSG的女性患者，共341例（单孔组100例，多孔组241例）。纳入标准包括年龄≥18岁、符合IFSO手术指征及完成基线数据采集；排除标准为严重精神疾病、腹部手术史或术后严重并发症。手术流程依据指南进行，单孔组采用单孔入路操作平台，多孔组参照标准腹腔镜手术流程。观察指标包括术前及术后3个月的体重、BMI、BAI、BDI、PSQI及SCAR评分，计算ΔBMI、%TWL、%EWL及心理评分变化。统计学分析采用R 4.4.3软件，计量资料以（±s）表示，组间比较采用独立样本t检验，计数资料采用Fisher确切概率法，倾向评分匹配采用1:1最近邻匹配法，P<0.05为差异有统计学意义。

基线资料比较显示，单孔手术组患者的年龄、体重、BMI、BAI评分、BDI评分及PSQI评分均显著低于多孔手术组（P<0.05），而腰围、臀围及腰臀比无显著差异（P>0.05）。术后3个月随访结果显示，单孔手术组在体重、BMI、BAI评分、ΔBAI、BDI评分、PSQI评分、ΔPSQI及SCAR评分方面均显著优于多孔手术组（P<0.05），但两组在ΔBMI、%TWL、%EWL及ΔBDI方面无显著差异（P>0.05）。倾向评分匹配后，两组基线资料无显著差异（P>0.05），术后三月单孔手术组在BAI评分、BDI评分、PSQI评分、SCAR评分及心理评分变化（ΔBAI、ΔBDI、ΔPSQI）方面仍显著优于多孔手术组（P<0.05）。中介效应分析显示，手术方式对术后三月心理状况变化的直接效应及总效应均显著，但通过SCAR评分的间接效应不显著。两组术后并发症发生率无显著差异（P>0.05），主要包括切口脂肪液化、切口血肿、肺部感染及术后出血，均经治疗后恢复。

单孔LSG在术后心理状态改善及切口美观度方面优于多孔LSG，但减重效果及安全性相当，未来需进一步验证其长期优势及机制。

This study aimed to compare the differences between single-port laparoscopic sleeve gastrectomy (LSG) and multi-port LSG in terms of short-term postoperative weight loss, psychological status improvement, and patient satisfaction with incisions. It further explored the clinical advantages and potential mechanisms of single-port LSG to provide a scientific basis for individualized surgical options for obese patients.

This retrospective analysis included 341 female patients who underwent sleeve gastrectomy at Shanghai Sixth People's Hospital from September 2023 to December 2024 (100 in the single-port group and 241 in the multi-port group). Inclusion criteria were age≥18 years, meeting IFSO surgical indications, and completion of baseline data collection. Exclusion criteria included severe mental illness, history of abdominal surgery, or severe postoperative complications. Surgical procedures followed guidelines, with the single-port group using a single-port access platform and the multi-port group following standard laparoscopic procedures. Observation indicators included preoperative and 3-month postoperative weight, BMI, BAI, BDI, PSQI, and SCAR scores, with calculations of ΔBMI, %TWL, %EWL, and changes in psychological scores. Statistical analysis was performed using R 4.4.3 software. Continuous data were expressed as mean ± standard deviation, and intergroup comparisons were conducted using independent samples t-tests. Categorical data were analyzed using Fisher's exact test, and propensity score matching was performed using a 1:1 nearest-neighbor matching method. P<0.05 was considered statistically significant.

Baseline data comparison showed that the single-port group had significantly lower age, weight, BMI, BAI score, BDI score, and PSQI score than the multi-port group (P<0.05), while waist circumference, hip circumference, and waist-to-hip ratio showed no significant difference (P>0.05). Three-month postoperative follow-up results revealed that the single-port group performed significantly better in weight, BMI, BAI score, ΔBAI, BDI score, PSQI score, ΔPSQI, and SCAR score (P<0.05), but no significant differences were observed between the two groups in ΔBMI, %TWL, %EWL, or ΔBDI (P>0.05). After propensity score matching, baseline characteristics showed no significant differences (P>0.05). At three months postoperatively, the single-port group still demonstrated superior BAI score, BDI score, PSQI score, SCAR score, and changes in psychological scores (ΔBAI, ΔBDI, ΔPSQI) compared to the multi-port group (P<0.05). Mediation analysis indicated that the surgical approach had significant direct and total effects on postoperative psychological changes, but the indirect effect through SCAR score was not significant. No significant difference was observed in postoperative complication rates (P>0.05), which mainly included incision fat liquefaction, incision hematoma, pulmonary infection, and postoperative bleeding, all of which resolved after treatment.

Single-port LSG outperforms multi-port LSG in postoperative psychological improvement and incision aesthetics, but weight loss efficacy and safety are comparable. Further validation of its long-term advantages and mechanisms is warranted.