腹腔镜袖状胃切除术治疗肥胖症及其合并疾病的疗效分析

doi:10.3877/cma.j.issn.1674-0793.2020.04.005

目的

探讨腹腔镜袖状胃切除术（LSG）治疗肥胖症患者的减重效果及其对合并疾病的改善情况，评估手术安全性。

方法

回顾性分析2016年1月至2018年12月在贵州省人民医院接受LSG手术的58例肥胖症患者临床资料，观察患者术后减重效果、合并疾病改善情况及术后并发症发生情况。

结果

患者均顺利完成LSG手术，术后第3、6、12个月平均多余体质量减轻百分比（%EWL）分别为（65.4±12.3）%、（71.2%±15.2）%、（74.7±16.7）%；合并疾病脂肪肝、肝功能异常、血脂异常、呼吸睡眠暂停综合征、高血压、2型糖尿病和高尿酸血症的术后1年疾病缓解率分别为74.3%、78.3%、70.0%、56.3%、85.7%、100.0%、80.0%，术后均得到显著改善（P<0.05）。术后近期并发症发生率为3.4%（2/58），远期并发症主要为胃食管反流症、胆囊结石和急性胰腺炎。

结论

LSG可有效减轻肥胖患者的体质量，改善肥胖相关合并疾病，而且手术并发症发生率较低，相对安全，值得推广。

关键词: 胃切除术, 肥胖症, 多余体质量减轻百分比, 合并疾病, 并发症

Objective

To analyze the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) in treating obesity and its co-morbidities.

Methods

The clinical data of fifty-eight patients with obesity who underwent LSG in Guizhou Provincial People’s Hospital from January 2016 to December 2018 were retrospectively analyzed. The effect of weight loss, the improvement of combined diseases and postoperative complications were observed.

Results

All operations were successfully completed in LSG. The mean %EWL at 3, 6 and 12 months after surgery were (65.4±12.3)%, (71.2%±15.2)% and (74.7±16.7)% respectively. The combined diseases were fatty liver, liver dysfunction, dyslipidemia, obstructive sleep apnea, hypertension, type 2 diabetes mellitus and hyperuricemia, which were significantly improved by 74.3%, 78.3%, 70.0%, 56.3%, 85.7%, 100.0% and 80.0% one year after surgery. Early complications occurred in 3.4% (2/58) of patients, and the common late complications were gastroesophageal reflux disease, cholecystolithiasis and acute pancreatitis.

Conclusion

LSG is effective and safe in treating obesity and its co-morbidities.

Key words: Gastrectomy, Obesity, Percentage of excess weight loss, Combined diseases, Complication

表1 58例肥胖症患者术前及术后12个月合并疾病的改善情况[例(%)]

时间	脂肪肝	肝功能异常	血脂异常	呼吸睡眠暂停综合征	高血压	2型糖尿病	高尿酸血症
术前	35(60.3)	23(39.7)	20(34.4)	16(27.6)	14(24.1)	11(19.0)	10(17.2)
术后12个月	9(32.8)	5(8.6)	6(10.3)	7(12.1)	2(3.4)	0(0)	2(3.4)
χ2值	24.752	15.253	9.716	4.393	10.440	12.152	5.949
P值	<0.001	<0.001	0.002	0.036	0.001	<0.001	0.015

表1 58例肥胖症患者术前及术后12个月合并疾病的改善情况[例(%)]

时间	脂肪肝	肝功能异常	血脂异常	呼吸睡眠暂停综合征	高血压	2型糖尿病	高尿酸血症
术前	35(60.3)	23(39.7)	20(34.4)	16(27.6)	14(24.1)	11(19.0)	10(17.2)
术后12个月	9(32.8)	5(8.6)	6(10.3)	7(12.1)	2(3.4)	0(0)	2(3.4)
χ2值	24.752	15.253	9.716	4.393	10.440	12.152	5.949
P值	<0.001	<0.001	0.002	0.036	0.001	<0.001	0.015

图1 58例肥胖症患者腹腔镜袖状胃切除术后体质量减轻情况　A为体质量；B为体质指数（BMI）；C为多余体质量减轻百分比（%EWL）；*P<0.05，**P<0.01

[1]	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖和2型糖尿病外科治疗指南(2014) [J]. 糖尿病临床, 2014, 8(11): 499-504.
[2]	Vranešić Bender D, Krznarić Z. Nutritional and behavioral modification therapies of obesity: facts and fiction[J]. Dig Dis, 2012, 30(2): 163-167.
[3]	Rebibo L, Maréchal V, De Lameth I, et al. Compliance with a multidisciplinary team meeting’s decision prior to bariatric surgery protects against major postoperative complications[J]. Surg Obes Relat Dis, 2017, 13(9): 1537-1543.
[4]	Schauer PR, Bhatt DL, Kashyap SR. Bariatric surgery or intensive medical therapy for diabetes after 5 years[J]. N Engl J Med, 2017, 376(20): 1997.
[5]	Helmiö M, Victorzon M, Ovaska J, et al. Comparison of short-term outcome of laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: A prospective randomized controlled multicenter SLEEVEPASS study with 6-month follow-up[J]. Scand J Surg, 2014, 103(3): 175-181.
[6]	Snehalatha C, Viswanathan V, Ramachandran A. Cutoff values for normal anthropometric variables in asian Indian adults[J]. Diabetes Care, 2003, 26(5): 1380-1384.
[7]	Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient[J]. Obes Surg, 2004, 14(4): 492-497.
[8]	Boza C, Daroch D, Barros D, et al. Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure[J]. Surg Obes Relat Dis, 2014, 10(6): 1129-1133.
[9]	Deitel M, Gagner M, Erickson AL, et al. Third International Summit: current status of sleeve gastrectomy[J]. Surg Obes Relat Dis, 2011, 7(6): 749-759.
[10]	Rawlins L, Rawlins MP, Brown CC, et al. Sleeve gastrectomy: 5-year outcomes of a single institution[J]. Surg Obes Relat Dis, 2013, 9(1): 21-25.
[11]	Wang X, Chang XS, Gao L, et al. Effectiveness of laparoscopic sleeve gastrectomy for weight loss and obesity-associated co-morbidities: A 3-year outcome from Mainland Chinese patients[J]. Surg Obes Relat Dis, 2016, 12(7): 1305-1311.
[12]	Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial[J]. JAMA, 2018, 319(3): 255-265.
[13]	Salminen P, Helmiö M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial[J]. JAMA, 2018, 319(3): 241-254.
[14]	Nath A, Leblanc KA, Hausmann MG, et al. Laparoscopic sleeve gastrectomy: our first 100 patients[J]. JSLS, 2010, 14(4): 502-508.
[15]	Pradarelli JC, Varban OA, Ghaferi AA, et al. Hospital variation in perioperative complications for laparoscopic sleeve gastrectomy in Michigan[J]. Surgery, 2016, 159(4): 1113-1120.
[16]	Nath A, Yewale S, Tran T, et al. Dysphagia after vertical sleevegastrectomy: evaluation of risk factors and assessment of endoscopic intervention[J]. World J Gastroenterol, 2016, 22(47): 10371-10379.
[17]	Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management[J]. World J Gastroenterol, 2014, 20(38): 13904-13910.
[18]	Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study[J]. Obes Surg, 2010, 20(4): 447-453.
[19]	Durmush EK, Ermerak G, Durmush D. Short-term outcomes of sleeve gastrectomy for morbid obesity: does staple line reinforcement matter?[J]. Obes Surg, 2014, 24(7): 1109-1116.

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Effectiveness of laparoscopic sleeve gastrectomy in treating obesity and the co-morbidities

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Effectiveness of laparoscopic sleeve gastrectomy in treating obesity and the co-morbidities