两种腹腔镜代谢手术方法治疗超级肥胖患者30例分析

doi:10.3877/cma.j.issn.1674-3946.2020.02.008

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 128 -131. doi: 10.3877/cma.j.issn.1674-3946.2020.02.008

所属专题：经典病例；经典病例；文献；

论著

两种腹腔镜代谢手术方法治疗超级肥胖患者30例分析

赵英杰¹, 曹李², 金露佳², 董光龙²^,^†(

)

^1. 解放军总医院第八医学中心普外科
^2. 解放军总医院第一医学中心普外科

收稿日期:2019-01-24 出版日期:2020-04-26
通信作者: 董光龙

Therapuetic Treatment of super obesity by laparoscopic metabolic surgery, report of 30 cases

Yingjie Zhao¹, Li Cao², Lujia Jin², Guanglong Dong²^,^†()

^1. Department of General Surgery, the 8th Medical Center of PLA General Hospital, Beijing, China
^2. Department of General Surgery, the 1st Medical Center of PLA General Hospital, Beijing, China

Received:2019-01-24 Published:2020-04-26
Corresponding author: Guanglong Dong
About author:
Corresponding author: Dong Guanglong , Email: gldong301@163.com
Supported by:
Capital clinical characteristic application research and achievement promotion fundation(NO.Z15110000405209)

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目的

探讨两种代谢手术治疗超级肥胖的疗效及安全性。

方法

回顾性分析2011年3月至2017年11月30例超级肥胖患者的临床资料和随访资料。根据手术方式不同，分为腹腔镜袖状胃切除术组(LSG，9例)和腹腔镜Roux－en－Y胃旁路术组(LRYGB，21例)。数据采用SPSS21.0统计分析，术前术后各项指标、额外体重减轻百分比(%EWL)用(±s)表示，独立t检验；术后早期及远期并发症、代谢合并症的改善情况使用χ²检验；P<0.05差异有统计学意义。

结果

30例患者均成功完成腹腔镜手术，无中转开腹。两组患者在术后6个月内%EWL上升明显，之后上升缓慢。LSG组少于LRYGB组(P<0.01)，提示LRYGB组的短期减重疗效优于LSG组。LSG组1例患者术后第2天出现胃切缘出血，再次手术修补。LRYGB组1例患者术后6个月出现脱发和骨质疏松，两组术后早期及远期并发症差异无统计学意义(P>0.05)。

结论

两种代谢手术治疗超级肥胖及其合并症短期内安全有效。

关键词: 超级肥胖症, 治疗结果, 手术后并发症, 腹腔镜, 代谢手术

Objective

To investigate the efficacy and safety of two types of laparoscopic metabolic surgery in treating super obesity.

Methods

Form March 2011 to November 2017, clinical data of 30 patients with super obesity were analyzed retrospectively. There were 9 cases underwent laparoscopic sleeve gastrectomy (LSG group) and 21 cases received laparoscopic Roux-en-Y gastric bypass (LRYGB group). Statistical analysis were performed by using SPSS 21.0 software package. Measurement data such as perioperative indicators, postoperative clinical indicators and Percentage of extra weight loss (%EWL) were expressed as (±s) and examined by using independent t-test. Count data such as short- and long-term complication rate and efficacy were compared by using χ² test. A P value of <0.05 was considered as statistically significant difference.

Results

30 patients underwent laparoscopic surgery successfully without conversion to open surgery. The% EWL of the two groups increased significantly within 6 months after operation, and then increased slowly. LSG group was less than LRYGB group (P<0.01), suggesting that the short-term weight loss effect of LRYGB group was better than LSG group. One patient in LSG group had bleeding at the cutting edge of stomach 2 days after operation, and underwent reoperation. One patient in LRYGB group had alopecia and osteoporosis 6 months after operation. There was no significant difference in the early and long-term complications between the two groups (P>0.05).

Conclusions

Both LSG and LRYGB for the treatment of super obesity are safe and effective during short term follow-up period.

Key words: Super obesity, Treatment outcome, Postoperative complications, Laparoscopes, Metabolic surgery

表1 30例原发性超级肥胖患者不同术式两组患者基本资料比较[(±s)，例]

组别	例数	男性	年龄(岁)	BMI (kg/m²)	T2MD
LSG	9	5	37.1±9.9	54.7±2.6	4
LRYGB	21	13	37.8±8.5	56.1±2.4	18
t/χ²值		0.745	0.826	0.664	0.019
P值		>0.05	>0.05	>0.05	<0.05
组别	例数	高血压	OSAS	胆囊结石	膝关节炎
LSG	9	3	4	1(11.1)	2
LRYGB	21	10	12	4(19.0)	5
t/χ²值		0.469	0.523	0.593	0.925
P值		>0.05	>0.05	>0.05	>0.05

表1 30例原发性超级肥胖患者不同术式两组患者基本资料比较[(±s)，例]

组别	例数	男性	年龄(岁)	BMI (kg/m²)	T2MD
LSG	9	5	37.1±9.9	54.7±2.6	4
LRYGB	21	13	37.8±8.5	56.1±2.4	18
t/χ²值		0.745	0.826	0.664	0.019
P值		>0.05	>0.05	>0.05	<0.05
组别	例数	高血压	OSAS	胆囊结石	膝关节炎
LSG	9	3	4	1(11.1)	2
LRYGB	21	10	12	4(19.0)	5
t/χ²值		0.469	0.523	0.593	0.925
P值		>0.05	>0.05	>0.05	>0.05

图1 30例原发性肥胖患者不同术式两组患者术后12个月内%EWL变化趋势

图2 30例原发性肥胖患者不同术式两组患者术后12个月甘油三脂水平

[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．代谢外科修正手术东亚专家共识(2018)[J/CD]．中华肥胖与代谢病电子杂志，2018，4(1)：1-4.
[2]	Bettencourt－Silva R, Neves JS, Pedro J，et al.Comparative Effectiveness of Different Bariatric Procedures in Super Morbid Obesity[J]．Obes Surg，2019，29(1)：281-291.
[3]	Angrisani L, Santonicola A, Iovino P, et al.Bariatric surgery and Endoluminal procedures: IFSO worldwide survey 2014[J]．Obes Surg，2017，27(9)：2279-2289.
[4]	董光龙，杜锦，冯杰，等．代谢外科中的多学科协作与区域合作[J/CD]．中华肥胖与代谢病电子杂志， 2016，8(3)：129-132.
[5]	董光龙，刘兢文，菅雁兵，等．袖状胃切除术作为胃束带术失败后修正手术的临床研究[J/CD]．中华肥胖与代谢病电子杂志，2015，1(1)：21-25.
[6]	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]．中国实用外科杂志， 2014，34(11)：1005-1010.
[7]	张鹏，郑成竹．减重代谢手术治疗2型糖尿病全球联合指南解读[J]．中华胃肠外科杂志，2017，20(4)：372-377.
[8]	Zerrweck C, Sepúlveda EM, Maydón HG, et al.Laparoscopic gastric bypass vs. sleeve gastrectomy in the super obese patient: early outcomes of an observational study[J]．Obes Surg，2014，24(5)：712-717.
[9]	Jain D，Sill A，Averbach A．Do patients with higher baseline BMI have improved weight loss with Roux－en－Y gastric bypass versus sleeve gastrectomy？[J]．Surg Obes Relat Dis，2018，14(9)：1304-1309.
[10]	Onyewu SC, Ogundimu OO, Ortega G，et al.Bariatric surgery outcomes in black patients with super morbid obesity：a 1－year postoperative review[J]．Am J Surg，2017，213(1)：64-68.
[11]	曾子杨，孙娟，康维明．减重代谢手术的历史、现状与展望[J]．中国医学科学院学报，2018，40(5)：581-590.
[12]	Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy[J]．Surg Obes Relat Dis, 2016, 12(4)：750-756.
[13]	董光龙，金露佳．对腹腔镜胃袖状切除术的再思考[J]．外科理论与实践，2018，23(6)：481-485.
[14]	Li J, Lai D, Wu D．Laparoscopic Roux－en－Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy to Treat Morbid Obesity－Related Comorbidities: a Systematic Review and Meta－analysis[J]．Obes Surg，2016，26(2)：429-442.
[15]	Celio AC，Wu Q，Kasten KR，et al.Comparative effectiveness of Roux－en－Y gastric bypass and sleeve gastrectomy in super obese patients[J]．Surg Endosc，2017，31(1)：317-323.
[16]	Salminen P，Helmi? 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.
[17]	申晓军，印慨．胃旁路术还是袖状胃切除术：从两项最新RCT研究看当前减重手术方式选择[J/CD]．中华肥胖与代谢病电子杂志，2018, 4(1): 12-15.
[18]	Stenberg E，Szabo E，Ottosson J，et al.Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database[J]．Br J Surg，2017，104(5)：562-569.

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