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

所属专题：文献；

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)

全文 ( ) 下载PDF ( ) 导出引用

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/OL]. 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/OL]. 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

[1]	Jammu GS, Sharma R. A 7－Year Clinical Audit of 1107 Cases Comparing Sleeve Gastrectomy, Roux－En－Y Gastric Bypass, and Mini－Gastric Bypass, to Determine an Effective and Safe Bariatric and Metabolic Procedure[J]. Obes Surg, 2016, 26(5):926-932.
[2]	Sheu EG, Channick R, Gee DW. Improvement in severe pulmonary hypertension in obese patients after laparoscopic gastric bypass or sleeve gastrectomy[J]. Surg Endosc, 2016, 30(2):633-637.
[3]	Shimada S, Sawada N, Ishiyama Y, et al. Impact of obesity on short－ and long－term outcomes of laparoscopy assisted distal gastrectomy for gastric cancer[J]. Surg Endosc, 2018, 32(1):358-366.
[4]	Antoniou SA, Antoniou GA, Koch OO, et al. Laparoscopic versus open obesity surgery: a meta－analysis of pulmonary complications[J]. Dig Surg, 2015, 32(2):98-107.
[5]	Mehari A, Afreen S, Ngwa J，et al. Obesity And Lung Function In African Americans[J]. Plos One, 2015, 10(10):e0140610-e0140610.
[6]	Lozano LM, Tió M, Rios J, et al. Severe and morbid obesity (BMI ≥ 35 kg/m² ) does not increase surgical time and length of hospital stay in total knee arthroplasty surgery[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(6):1713-1719.
[7]	Abdemur A, Han S M, Lo M E, et al. Reasons and outcomes of conversion of laparoscopic sleeve gastrectomy to Roux－en－Y gastric bypass for nonresponders[J]. Surg Obes Relat Dis, 2016, 12(1):113-118.
[8]	Cauchi D, Glonti K, Petticrew M, et al. Environmental components of childhood obesity prevention interventions: an overview of systematic reviews[J]. Obes Rev, 2016, 17(11):1116-1130.
[9]	Ross SE, Flynn JI, Pate RR. What is really causing the obesity epidemic? A review of reviews in children and adults[J]. J Sports Sci, 2016, 34(12):1148-1153.
[10]	Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980－2013: a systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet, 2014, 384(9945):766-781.
[11]	田爱钊. 腹腔镜下胆囊切除术对肥胖患者术后切口脂肪液化的临床观察[J/CD]. 中华普外科手术学杂志(电子版), 2016, 10(3):265-267.
[12]	林懋全，王存川，杨景哥，等. LRYGB和LSG治疗T2DM的疗效及对GLP－1和Ghrelin水平的影响[J/CD]. 中华肥胖与代谢病杂志(电子版), 2015, 1(2):80-84.
[13]	Osland E, Yunus RM, Khan S, et al. Late Postoperative Complications in Laparoscopic Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux－en－y Gastric Bypass (LRYGB): Meta－analysis and Systematic Review[J]. Surg Laparosc Endosc Percutan Tech, 2016, 26(3):193-201.
[14]	Perrone F, Bianciardi E, Ippoliti S, et al. Long－term effects of laparoscopic sleeve gastrectomy versus Roux－en－Y gastric bypass for the treatment of morbid obesity: a monocentric prospective study with minimum follow－up of 5 years[J]. Updates Surg, 2017, 69(1):101-107.
[15]	刘殿刚，张若蹊，张超，等. 代谢手术治疗肥胖合并代谢综合征的Meta分析－－袖状胃切除术与胃旁路术疗效比较[J]. 国际外科学杂志，2017, 44(2):104-109.
[16]	Alsabah SK, Almazeedi SM, Dashti SA, et al. The efficacy of laparoscopic sleeve gastrectomy in treating adolescent obesity[J]. Obes Surg, 2015, 25(1):50-54.
[17]	Quirante FP, Montorfano L, Ahmad H, et al. The effect of procedure choice. LRYGB vs LSG[J]. Surgery for Obesity & Related Diseases, 2016, 12(7):S137-S138.
[18]	任庆贵，张弘玮，董维峰，等. 胃旁路术和袖状胃切除术对重度肥胖患者疗效对比分析[J]. 中华内分泌外科杂志，2016, 10(6):474-477.
[19]	Yoon J, Sherman J, Argiroff A, et al. Laparoscopic Sleeve Gastrectomy and Gastric Bypass for The Aging Population[J]. Obes Surg, 2016, 26(11):2611-2615.
[20]	李殿启，崔伟，李健，等. 腹腔镜与传统开放修补术治疗超重与肥胖患者腹壁切口疝的对比分析[J/CD]. 中华普外科手术学杂志(电子版), 2017, 11(1):43-45.

[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]	赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[11]	李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[12]	韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[13]	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.
[14]	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.
[15]	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.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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