重度肥胖患者应用腹腔镜下袖状胃切除术与胃旁路术治疗前后肺功能及血脂水平变化分析

doi:10.3877/cma.j.issn.1674-3946.2018.03.019

中华普外科手术学杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 242 -245. doi: 10.3877/cma.j.issn.1674-3946.2018.03.019

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论著

重度肥胖患者应用腹腔镜下袖状胃切除术与胃旁路术治疗前后肺功能及血脂水平变化分析

鲁旭¹^,^†(

), 鲁宏艺¹, 钱赢¹, 吴亚东¹, 金小顺¹, 孙喜太²

^1. 239000　安徽，滁州市第一人民医院暨安徽医科大学滁州临床学院普外科
^2. 210000　南京，南京鼓楼医院暨南京大学医学院附属鼓楼医院普外科

收稿日期:2018-03-01 出版日期:2018-06-26
通信作者: 鲁旭

Analysis of changes in pulmonary function and blood lipid levels in patients with severe obesity after laparoscopic sleeve gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass

Xu Lu¹^,^†(), Hongyi Lu¹, Ying Qian¹, Yadong Wu¹, Xiaoshun Jin¹, Xitai Sun²

^1. Department of General Surgery, Chuzhou First People’s Hospital and Chuzhou Clinical College of Medical University Of Anhui, Chuzhou 239000, China
^2. Department of general surgery, Drum Tower Hospital Affiliated to Nanjing Gulou Hospital and Nanjing University medical school, Nanjing, Jiangsu 210000, China

Received:2018-03-01 Published:2018-06-26
Corresponding author: Xu Lu
About author:
Corresponding author: Lu Xu, Email: guibu0808@163.com
Supported by:
Chuzhou science and technology guidance plan project in 2016(No. 201603)

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引用本文：

鲁旭, 鲁宏艺, 钱赢, 吴亚东, 金小顺, 孙喜太. 重度肥胖患者应用腹腔镜下袖状胃切除术与胃旁路术治疗前后肺功能及血脂水平变化分析[J]. 中华普外科手术学杂志(电子版), 2018, 12(03): 242-245.

Xu Lu, Hongyi Lu, Ying Qian, Yadong Wu, Xiaoshun Jin, Xitai Sun. Analysis of changes in pulmonary function and blood lipid levels in patients with severe obesity after laparoscopic sleeve gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(03): 242-245.

目的

对比腹腔镜下袖状胃切除术(LSG)与胃旁路术(LRYGB)对重度肥胖患者肺功能及血脂水平的影响。

方法

回顾性分析2014年11月至2017年11月2个医院收治的重度肥胖(BMI≥35kg/m²)患者90例，患者接受LSG(n＝48)或LRYGB(n＝42)治疗。采用SPSS 19.0进行统计学分析，一般资料、肺功能指标、生理指标、血脂水平的比较采用(±s)，组间比较采用独立t检验或单因素方差分析；计数资料采用χ²检验。P<0.05表示统计学差异显著。

结果

LSG组手术时间与麻醉时间均低于LRYGB组，差异有统计学意义(P<0.05)，两组术中出血量比较无明显统计学意义(P>0.05)；术前两组肺功能的比较差异无统计学意义。术后两组PaO₂、FVC、FEV1和MMF均较术前明显下降(P<0.05)。术后48 h，上述指标均较术后24 h改善(P<0.05)，但仍较术前水平低(P<0.05); LSG组术后24 h、48 h的上述指标均较LRYGB组高，差异有统计学意义(P<0.05)。与术前比较，两组术后6个月体重、BMI、腰围、臀围、空腹血糖和餐后2 h血糖均明显下降(P<0.05)；与术前比较，两组术后6个月TG、CH、LDL水平均明显下降，而HDL水平明显升高(P<0.05)，组间比较差异均无统计学意义(P>0.05)。(P>0.05)。

结论

LRYGB和LSG减肥疗效相当，对血脂的改善无明显差异，但是LSG对患者短期肺功能和氧合的影响较LRYGB小。

关键词: 肥胖症, 腹腔镜, 胃切除术, 呼吸功能试验

Objective

To compare the effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on pulmonary function and blood lipid levels in patients with severe obesity.

Methods

90 patients with severe obesity (BMI ≥ 35kg/m²) admitted to two hospitals from November 2014 to November 2017 were analyzed retrospectively, and the patients were treated with LSG (n=48) or LRYGB (n=42). The SPSS 19.0 was used for statistical analysis, and the general data, lung function indexes, physiological indexes and blood lipid levels were compared by (±s). The independent t test or one-way ANOVA was used for comparison between groups. The enumeration data was tested by χ². P<0.05 indicated that the statistical difference was significant.

Results

The surgical and anesthesia durations in LSG group were lower than those in LRYGB group, and the differences were statistically significant (P<0.05). And the amount of blood loss during surgery between the two groups showed no statistically significant difference (P>0.05). There was no significant difference in lung function between the groups before surgery. The levels of PaO₂, FVC, FEV1 and MMF in both groups were all significantly decreased after surgery (P<0.05). The levels of PaO₂, FVC, FEV1 and MMF in both groups at 48 h after surgery were all significantly improved than those at 24 h after surgery (P<0.05), but were still significantly lower than those before surgery (P<0.05). The levels of PaO₂, FVC, FEV1 and MMF in LSG group were all higher than those in LRYGB group at 24 h and 48 h after surgery, and the differences were statistically significant (P<0.05). The levels of weight, BMI, waist circumference, hip circumference, fasting blood glucose and 2-hour postprandial blood glucose in both groups at 6 months after surgery were all decreased than those before surgery, and the differences were statistically significant (P<0.05); however, there was no statistically significant difference between the two groups (P>0.05). The levels of TG, CH and LDL in both groups at 6 months after surgery were significantly decreased than those before surgery, while the HDL level was significantly increased (P < 0.05); however, there was no statistically significant difference between the two groups (P>0.05).

Conclusion

LRYGB and LSG have the similar result in weight loss and have no significant difference in improving blood lipids, but LSG has less effects on short-term lung function and oxygenation compared with LRYGB.

Key words: Obesity, Laparoscopes, Gastrectomy, Respiratory Function Tests

表1 90例重度肥胖患者不同减重手术两组一般资料比较(±s)

项目	LRYGB组(n＝42)	LSG组(n＝48)	t/χ²值	P值
性别(男/女)	28/14	31/17	0.043	0.836
年龄(岁)	39.8±7.8	38.4±10.2	0.723	0.471
体重(kg)	105.2±12.4	108.5±11.5	1.309	0.194
BMI(kg/m²)	38.8±1.2	39.4±2.2	1.574	0.119
腰围(cm)	117.5±8.4	120.1±8.1	1.493	0.139
臀围(cm)	119.5±9.4	121.1±5.7	0.990	0.325
空腹血糖(mmol/l)	9.1±1.2	9.5±2.3	1.012	0.314
餐后2 h血糖(mmol/l)	18.1±5.3	18.4±4.9	0.279	0.781

表1 90例重度肥胖患者不同减重手术两组一般资料比较(±s)

项目	LRYGB组(n＝42)	LSG组(n＝48)	t/χ²值	P值
性别(男/女)	28/14	31/17	0.043	0.836
年龄(岁)	39.8±7.8	38.4±10.2	0.723	0.471
体重(kg)	105.2±12.4	108.5±11.5	1.309	0.194
BMI(kg/m²)	38.8±1.2	39.4±2.2	1.574	0.119
腰围(cm)	117.5±8.4	120.1±8.1	1.493	0.139
臀围(cm)	119.5±9.4	121.1±5.7	0.990	0.325
空腹血糖(mmol/l)	9.1±1.2	9.5±2.3	1.012	0.314
餐后2 h血糖(mmol/l)	18.1±5.3	18.4±4.9	0.279	0.781

表2 90例重度肥胖患者不同减重手术两组肺功能的比较(±s)

项目	LRYGB组(n＝42)
项目	术前	术后24 h	术后48 h
PH	7.3±0.4	7.3±0.1	7.3±0.3
PaO₂ (mmHg)	98.4±1.2	83.1±1.1^b	93.1±2.4^ba
PaCO₂ (mmHg)	37.5±1.5	38.1±0.2	36.9±0.1
FVC(V/L)	3.4±0.2	1.1±0.1^b	2.0±0.4^ba
FEV1(V/L)	2.7±0.1	0.7±0.01^b	1.8±0.1^ba
MMF(V/L)	2.6±0.1	0.7±0.2^b	1.3±0.4^ba
项目	LSG组(n＝48)
项目	术前	术后24 h	术后48 h
PH	7.3±0.1	7.4±0.1	7.4±0.2
PaO₂ (mmHg)	99.0±1.0	88.2±2.4^bc	98.2±0.5^bac
PaCO₂ (mmHg)	37.2±1.0	37.8±0.0	37.0±1.0
FVC(V/L)	3.4±0.0	1.4±0.0^bc	2.97±0.2^bac
FEV1(V/L)	2.8±1.2	1.3±0.1^bc	2.1±0.1^bac
MMF(V/L)	2.5±0.5	1.2±0.4^bc	2.3±0.2^bac

表2 90例重度肥胖患者不同减重手术两组肺功能的比较(±s)

项目	LRYGB组(n＝42)
项目	术前	术后24 h	术后48 h
PH	7.3±0.4	7.3±0.1	7.3±0.3
PaO₂ (mmHg)	98.4±1.2	83.1±1.1^b	93.1±2.4^ba
PaCO₂ (mmHg)	37.5±1.5	38.1±0.2	36.9±0.1
FVC(V/L)	3.4±0.2	1.1±0.1^b	2.0±0.4^ba
FEV1(V/L)	2.7±0.1	0.7±0.01^b	1.8±0.1^ba
MMF(V/L)	2.6±0.1	0.7±0.2^b	1.3±0.4^ba
项目	LSG组(n＝48)
项目	术前	术后24 h	术后48 h
PH	7.3±0.1	7.4±0.1	7.4±0.2
PaO₂ (mmHg)	99.0±1.0	88.2±2.4^bc	98.2±0.5^bac
PaCO₂ (mmHg)	37.2±1.0	37.8±0.0	37.0±1.0
FVC(V/L)	3.4±0.0	1.4±0.0^bc	2.97±0.2^bac
FEV1(V/L)	2.8±1.2	1.3±0.1^bc	2.1±0.1^bac
MMF(V/L)	2.5±0.5	1.2±0.4^bc	2.3±0.2^bac

表3 90例重度肥胖患者不同减重手术两组术后6个月一般生理指标的比较(±s)

项目	LRYGB组(n＝42)
项目	术前	术后6月
体重(kg)	105.24±12.4	74.5±2.8^b
BMI(kg/m²)	38.8±1.2	27.1±0.2^b
腰围(cm)	117.5±8.4	95.2±4.3^b
臀围(cm)	119.5±9.4	101.2±8.2^b
空腹血糖(mmol/l)	9.1±1.2	6.2±0.8^b
餐后2 h血糖(mmol/l)	18.1±5.0	8.5±1.2^b
项目	LSG组(n＝48)
项目	术前	术后6月
体重(kg)	108.5±11.5	71.4±12.1^b
BMI(kg/m²)	39.4±2.2	29.7±0.5^b
腰围(cm)	120.1±18.1	9701±1.2^b
臀围(cm)	121.4±5.7	104.2±10.0^b
空腹血糖(mmol/l)	9.5±2.4	5.9±0.9^b
餐后2 h血糖(mmol/l)	18.2±4.9	9.1±1.3^b

表3 90例重度肥胖患者不同减重手术两组术后6个月一般生理指标的比较(±s)

项目	LRYGB组(n＝42)
项目	术前	术后6月
体重(kg)	105.24±12.4	74.5±2.8^b
BMI(kg/m²)	38.8±1.2	27.1±0.2^b
腰围(cm)	117.5±8.4	95.2±4.3^b
臀围(cm)	119.5±9.4	101.2±8.2^b
空腹血糖(mmol/l)	9.1±1.2	6.2±0.8^b
餐后2 h血糖(mmol/l)	18.1±5.0	8.5±1.2^b
项目	LSG组(n＝48)
项目	术前	术后6月
体重(kg)	108.5±11.5	71.4±12.1^b
BMI(kg/m²)	39.4±2.2	29.7±0.5^b
腰围(cm)	120.1±18.1	9701±1.2^b
臀围(cm)	121.4±5.7	104.2±10.0^b
空腹血糖(mmol/l)	9.5±2.4	5.9±0.9^b
餐后2 h血糖(mmol/l)	18.2±4.9	9.1±1.3^b

表4 90例重度肥胖患者不同减重手术两组术后6个月血脂水平的比较(±s)

项目	LRYGB组(n＝42)		LSG组(n＝48)
项目	术前	术后6月	术前	术后6月
TG	2.5±1.1	1.5±0.6^b	2.3±1.1	1.4±1.3^b
CH	4.8±1.5	4.1±1.1^b	4.6±1.8	4.3±2.1^b
HDL	1.3±0.5	1.5±0.1^b	1.2±0.3	1.5±0.1^b
LDL	3.2±0.2	3.1±0.5^b	2.4±0.8	2.9±0.1^b

表4 90例重度肥胖患者不同减重手术两组术后6个月血脂水平的比较(±s)

项目	LRYGB组(n＝42)		LSG组(n＝48)
项目	术前	术后6月	术前	术后6月
TG	2.5±1.1	1.5±0.6^b	2.3±1.1	1.4±1.3^b
CH	4.8±1.5	4.1±1.1^b	4.6±1.8	4.3±2.1^b
HDL	1.3±0.5	1.5±0.1^b	1.2±0.3	1.5±0.1^b
LDL	3.2±0.2	3.1±0.5^b	2.4±0.8	2.9±0.1^b

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Analysis of changes in pulmonary function and blood lipid levels in patients with severe obesity after laparoscopic sleeve gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass

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Analysis of changes in pulmonary function and blood lipid levels in patients with severe obesity after laparoscopic sleeve gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass