腹腔镜胆胰转流十二指肠转位术治疗中国肥胖患者可行性研究的初步探讨

doi:10.3877/cma.j.issn.1674-3946.2021.05.010

目的

初步探讨腹腔镜胆胰转流十二指肠转位术(BPD/DS)治疗中国肥胖患者的可行性及安全性。

方法

回顾性分析2019年9月至2020年1月期间11例接受BPD/DS治疗的肥胖症患者的临床资料。分析患者术后1年的各项指标。用SPSS 22.0统计软件进行分析。计量资料以(±s)表示，正态分布的计量资料采用配对t检验，偏态分布的计量资料采用Mann-Whitney U检验。P<0.05为差异有统计学意义。

结果

所有患者均成功施行BPD/DS，无中转开腹及死亡病例。术后1年的随访率为81.8%(9/11)。以下是术后1年的结果：体重、体质量指数分别为(77.3±15.8) kg和(25.6±5.3) kg/m²，较术前均显著下降(P<0.05)；收缩压、舒张压分别为(119.3±17.2) mmHg和(76.1±13.4) mmHg，较前术前均显著降低(P<0.05)，高血压缓解率为77.7%(7/9)；高尿酸血症缓解率为66.7%(4/6)；术后1年的2型糖尿病缓解率为100.0%(4/4)；术前异常升高的总胆固醇、甘油三酯和低密度脂蛋白在术后1年的缓解率分别为100.0%(4/4)、100.0%(3/3)和100.0%(6/6)。共5例患者出现并发症：术后腹腔出血1例、十二指肠回肠吻合口漏1例、小肠梗阻1例、慢性贫血(Hb：97.0g/L)1例、慢性肝实质损害1例。术后1年获得随访的9例患者的锌、维生素E、叶酸、白蛋白较术前均显著下降(P<0.05)，其低于正常值范围的百分比分别为44.4%(4/9)、55.5%(5/9)、0%(0/9)、22.2%(2/9)。9例患者术后1年的血清氯较术前显著升高(P<0.05)。

结论

虽然BPD/DS对肥胖及其代谢病具有十分可观的疗效，但该术式的并发症发生率较高，可行性及安全性欠佳，需慎重开展该术式。

关键词: 肥胖症, 腹腔镜, 胆胰转流十二指肠转位术

Objective

To investigate the feasibility and safety of laparoscopic biliopancreatic diversion with duodenal switch(BPD/DS) preliminarily in the treatment of Chinese patients with obesity.

Methods

The clinical data of eleven patients with obesity treated with BPD/DS from September 2019 to January 2020 were analyzed retrospectively.We analyzed each index at one year after operation. Statistical analysis were performed by using SPSS 22.0 software. Measurement data were expressed as (±s). They were examined by using paired t test (Normality data) or Mann-Whitney U test (skewed data), as appropriate. A P value of <0.05 was considered as statistically significant difference.

Results

All of 11 patients underwent successfully BPD/DS without conversion to laparotomy or perioperative death. The follow-up rate at 1 year after surgery was 81.8% (9/11). The results in the first postoperative year were as follows: The body weight and body mass index were (77.3±15.8) kg and (25.6±5.3) kg/m², which decreased significantly than those of before operation respectively (P<0.05). The systolic blood pressure and diastolic blood pressure were (119.3±17.2) mmHg and (76.1±13.4) mmHg, which decreased significantly than those before operation respectively (P<0.05), and the remission rate of hypertension was 77.7% (7/9). The remission rate of hyperuricemia was 66.7% (4/6). The remission rate of type 2 diabetes mellitus 1 year after operation was 100.0% (4/4). The remission rate of total cholesterol, triglycerides, and low-density lipoprotein over the normal upper limit before operation were 100.0% (4/4), 100.0% (3/3), and 100.0% (6/6) at 1 year after surgery. There were five complications in total: 1 case of postoperative intraperitoneal hemorrhage, 1 case of duodenal-ileal anastomotic leakage, 1 case of intestinal obstruction, 1 case of chronic anemia (Hb: 97.0g/L) and 1 case of chronic hepatic parenchyma damage. The level of zinc, vitamin E, folic acid, and albumin of the 9 patients who were followed up in the first postoperative year decreased significantly than those before operation (P<0.05), and their percentages below the normal range were 44.4% (4/9), 55.5% (5/9), 0% (0/9) and 22.2% (2/9). The serum chlorine level of 9 patients at 1 year after operation increased significantly than those before operation respectively (P<0.05).

Conclusion

Although laparoscopic biliopancreatic diversion with duodenal switch is considered as giving a significant curative effect on obesity and its-related metabolic diseases, the complication rate of this operation is relatively high. Therefore, it needs to be carefully to carry out this procedure because the feasibility and safety of BPD/DS are not good.

Key words: Obesity, Laparoscopes, Biliopancreatic diversion with duodenal switch

图1 BPD/DS示意图^[10](胃袖状切除是在34Fr胃管指引下进行，食物支通道长度为200 cm，食物与胆胰液混合的共同通道长度为100 cm)

表1 9例肥胖患者腹腔镜BPD/DS术前术后体重及代谢指标对比(±s)

时间	体重(kg)	BMI(kg/m²)	收缩压(mmHg)	舒张压(mmHg)	FPG(mmol/L)
术前	135.3±23.0	45.1±9.7	152.1±17.2	99.7±13.5	10.5±4.0
术后1年	77.3±15.8	25.6±5.3	119.3±17.2	76.1±13.4	4.5±0.4
统计值	t＝10.272	t＝8.612	U＝9.000	t＝5.448	U＝0.000
P值	0.000	0.000	0.005	0.001	0.021
时间	HBA1c(%)	尿酸(umol/L)	TG(mmol/L)	TC(mmol/L)	LDL(mmol/L)
术前	8.9±1.5	530.8±77.3	7.1±7.8	5.8±0.7	3.7±0.1
术后1年	4.3±0.5	384.3±96.4	1.2±0.3	3.4±0.3	1.9±0.3
统计值	U＝0.000	t＝6.380	U＝0.000	U＝0.000	t＝15.305
P值	0.021	0.001	0.05	0.02	0.000

表1 9例肥胖患者腹腔镜BPD/DS术前术后体重及代谢指标对比(±s)

时间	体重(kg)	BMI(kg/m²)	收缩压(mmHg)	舒张压(mmHg)	FPG(mmol/L)
术前	135.3±23.0	45.1±9.7	152.1±17.2	99.7±13.5	10.5±4.0
术后1年	77.3±15.8	25.6±5.3	119.3±17.2	76.1±13.4	4.5±0.4
统计值	t＝10.272	t＝8.612	U＝9.000	t＝5.448	U＝0.000
P值	0.000	0.000	0.005	0.001	0.021
时间	HBA1c(%)	尿酸(umol/L)	TG(mmol/L)	TC(mmol/L)	LDL(mmol/L)
术前	8.9±1.5	530.8±77.3	7.1±7.8	5.8±0.7	3.7±0.1
术后1年	4.3±0.5	384.3±96.4	1.2±0.3	3.4±0.3	1.9±0.3
统计值	U＝0.000	t＝6.380	U＝0.000	U＝0.000	t＝15.305
P值	0.021	0.001	0.05	0.02	0.000

表2 9例肥胖患者腹腔镜BPD/DS术前术后5项营养指标对比(±s)

时间	氯(mmol/L)	锌(umol/L)	维生素E(ug/ml)	叶酸(ng/ml)	白蛋白(g/L)
术前	100.4±3.8	14.3±1.1	12.6±5.0	16.2±8.2	73.5±3.7
术后1年	105.0±4.8	11.4±1.9	6.2±1.7	9.2±4.9	39.3±4.9
统计值	t＝-3.095	t＝3.598	t＝3.613	t＝3.805	U＝0.000
P值	0.015	0.003	0.003	0.005	0.000

表2 9例肥胖患者腹腔镜BPD/DS术前术后5项营养指标对比(±s)

时间	氯(mmol/L)	锌(umol/L)	维生素E(ug/ml)	叶酸(ng/ml)	白蛋白(g/L)
术前	100.4±3.8	14.3±1.1	12.6±5.0	16.2±8.2	73.5±3.7
术后1年	105.0±4.8	11.4±1.9	6.2±1.7	9.2±4.9	39.3±4.9
统计值	t＝-3.095	t＝3.598	t＝3.613	t＝3.805	U＝0.000
P值	0.015	0.003	0.003	0.005	0.000

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Preliminary study of laparoscopic biliopancreatic diversion with duodenal switch in the treatment of Chinese patients with obesity

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Preliminary study of laparoscopic biliopancreatic diversion with duodenal switch in the treatment of Chinese patients with obesity