关键词: 腹腔镜袖状胃切除术, 两点一线, TPOL模型, 解剖标志

Abstract: 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.

Key words: laparoscopy Sleeve gastrectomy, two points and one line, two points and one line model model；anatomical landmark