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中华普外科手术学杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 27 -31. doi: 10.3877/cma.j.issn.1674-3946.2023.01.009

论著

超级肥胖患者术式选择及疗效分析
武现生1, 李丁昌1, 高文星1, 赵稳1, 陈鹏1, 金露佳1, 董光龙1,()   
  1. 1. 100853 北京,中国人民解放军总医院第一医学中心普通外科医学部
  • 收稿日期:2022-09-13 出版日期:2023-02-26
  • 通信作者: 董光龙

Surgical choice and curative effect analysis of super obese patients

Xiansheng Wu1, Dingchang Li1, Wenxing Gao1, Wen Zhao1, Peng Chen1, Lujia Jin1, Guanglong Dong1,()   

  1. 1. Department of General Surgery,The First Medical Center,PLA General Hospital,Beijing 100853,China
  • Received:2022-09-13 Published:2023-02-26
  • Corresponding author: Guanglong Dong
  • Supported by:
    Capital Clinical Characteristic Application Research and Achievement Promotion Fund(Z151100004015209)
引用本文:

武现生, 李丁昌, 高文星, 赵稳, 陈鹏, 金露佳, 董光龙. 超级肥胖患者术式选择及疗效分析[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(01): 27-31.

Xiansheng Wu, Dingchang Li, Wenxing Gao, Wen Zhao, Peng Chen, Lujia Jin, Guanglong Dong. Surgical choice and curative effect analysis of super obese patients[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(01): 27-31.

目的

探讨不同手术方式治疗超级肥胖患者(BMI≥50 kg/m2)的安全性及有效性。

方法

回顾性分析2016年3月至2020年9月期间37例超级肥胖患者的临床资料,根据术式不同分为腹腔镜可调节胃束带折叠术(LAGBP)、腹腔镜袖状胃切除术(LSG)、腹腔镜袖状胃切除术(LSG)+空肠旁路术(JJB)及腹腔镜Roux-en-Y胃旁路术(LRYGB)4组,各组患者分别为3例、10例、4例和20例。采用SPSS 21.0软件进行统计学分析。各组患者围手术期指标、减重效果及血脂、血糖、尿酸水平的改善情况用(

xˉ
±s)表示,手术前后指标比较使用配对样本t检验,组间两两比较采用多样本方差分析;并发症发生率等计数资料用频数(百分数)表示,使用Fisher确切概率检验。P<0.05差异有统计学意义。

结果

各组患者手术时间、术中出血量、腹腔引流量及术后排气时间差异无统计学意义(P>0.05),其中LAGBP组患者术后住院时间要明显低于其他各组(P<0.05)。LRYGB组和LSG+JJB组患者术后12个月内额外体重减轻百分比(EWL%)高于LSG组和LAGBP组(P<0.05)。各组患者术后空腹血糖及糖化血红蛋白含量较术前均有所降低,高脂血症及高尿酸血症也得到不同程度的改善。4组患者术后均出现相应的术后并发症,如胃切缘出血、恶心及胃食管反流等,但各组患者发生术后并发症差异无统计学意义(P>0.05)。

结论

短期随访结果显示,4种代谢手术方式治疗超级肥胖及其并发症均安全有效,且LRYGB及LSG+JJB术式减重效果要优于LAGBP及LSG。

Objective

To investigate the safety and effectiveness of different surgical methods in the treatment of super obese patients(BMI≥50 kg/m2).

Methods

The clinical data of 37 super obese patients from March 2016 to September 2020 were retrospectively analyzed. According to different surgical methods,the patients were divided into four groups:laparoscopic adjustable gastric band folding(LAGBP),laparoscopic sleeve gastrectomy(LSG),laparoscopic sleeve gastrectomy(LSG)+ jejunal bypass(JJB)and laparoscopic Roux-en-Y gastric bypass(LRYGB),with 3 cases,10 cases,4 cases and 20 cases in each group. SPSS 21.0 software was used for statistical analysis. Perioperative indicators,weight loss effect and improvement of blood lipid,blood glucose and uric acid levels in each group were represented by(

xˉ
±s). Paired sample t test was used for indicators comparison before and after surgery,and multiple source variance analysis was used for pairwise comparison between groups. Statistical data such as complication rate were expressed as frequency(percentage)and Fisher exact probability test was used. P<0.05 was statistically significant.

Results

There were no significant differences in operation time,intraoperative blood loss,abdominal drainage volume and postoperative exhaust time among all groups(P>0.05),and the postoperative hospital stay of LAGBP group was significantly lower than that of other groups. The percentage of additional weight loss(EWL%)in 12 months after surgery in LRYGB group and LSG+JJB group was higher than that in LSG and LAGBP group(P<0.05). The contents of fasting blood glucose and glycosylated hemoglobin in all groups were decreased after operation,and hyperlipidemia and hyperuricemia were also improved to varying degrees. Postoperative complications,such as gastric margin bleeding,nausea and gastroesophageal reflux,were found in all the 4 groups,but there was no statistical significance in postoperative complications among all groups(P>0.05).

Conclusion

The short-term follow-up results show that the four metabolic surgical methods are safe and effective in the treatment of super obesity and its complications,and the weight loss effect of LRYGB and LSG+JJB is better than that of LAGBP and LSG.

表1 37例超级肥胖减重手术4种不同术式患者基线特征比较[(
xˉ
±s),例]
表2 37例超级肥胖减重手术4种不同术式组别患者围手术期指标的比较(
xˉ
±s)
图1 37例超级肥胖减重手术4种不同术式组别患者术后12个月内EWL%变化情况注:c=P<0.001;ns=P>0.05
图2 37例超级肥胖减重手术4种不同术式组别患者手术前后空腹血糖值变化情况注:a=P<0.05;c=P<0.001;ns=P>0.05
图3 37例超级肥胖减重手术4种不同术式组别患者手术前后HbA1c值变化情况注:a=P<0.05;b=P<0.01;c=P<0.001
图4 37例超级肥胖减重手术4种不同术式组别患者手术前后血尿酸水平变化情况注:a=P<0.05;ns=P>0.05
表3 37例超级肥胖减重手术4种不同术式组别并发症发生率比较(例)
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