切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 150 -154. doi: 10.3877/cma.j.issn.1674-3946.2024.02.010

论著

不同入路腹腔镜袖状胃切除术用于肥胖症合并2型糖尿病的效果
刘盾1, 潘晟2,()   
  1. 1. 473000 湖北武汉,武汉科技大学胃肠外科
    2. 430000 湖北武汉,武汉科技大学附属普仁医院胃肠外科
  • 收稿日期:2023-05-25 出版日期:2024-04-26
  • 通信作者: 潘晟

Effect of different approaches of laparoscopic sleeve gastrectomy for obesity with type 2 diabetes mellitus

Dun Liu1, Sheng Pan2,()   

  1. 1. Department of Gastrointestinal Surgery,Wuhan University of Science and Technology, Wuhan Hubei Province 473000,China
    2. Department of Gastrointestinal Surgery, Puren Hospital Affiliated to Wuhan University of Science and Technology,Wuhan Hubei Province 430000, China
  • Received:2023-05-25 Published:2024-04-26
  • Corresponding author: Sheng Pan
  • Supported by:
    Wuhan Medical Research Project(WX20D06)
引用本文:

刘盾, 潘晟. 不同入路腹腔镜袖状胃切除术用于肥胖症合并2型糖尿病的效果[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(02): 150-154.

Dun Liu, Sheng Pan. Effect of different approaches of laparoscopic sleeve gastrectomy for obesity with type 2 diabetes mellitus[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(02): 150-154.

目的

探究不同入路腹腔镜袖状胃切除术(LSG)在肥胖症合并2型糖尿病(T2DM)患者治疗中的应用价值。

方法

回顾性分析2021年1月至2023年1月158例行LSG的肥胖症合并T2DM患者资料,依据手术入路不同分为两组,每组各79例。观察组采用比基尼线切口入路实施手术,对照组行常规切口实施手术。采用SPSS 22.0版统计学软件包进行数据分析,围手术期相关指标、炎症应激指标[去甲肾上腺素(NE)、皮质醇(COR)、C反应蛋白(CRP)、白细胞介素(IL-6)]、糖脂代谢指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)]、体重指数(BMI)和切口美观满意度(CS)评分等计量资料以()表示,行独立样本t检验。计数资料额外增加孔数及并发症用百分比表示,采用χ2检验。P<0.05表示差异具有统计学意义。

结果

观察组额外增加孔数少于对照组,患者术后排气时间及住院天数短于对照组(P<0.05);观察组患者术后1 d、3 d血清COR、NE、CRP、IL-6水平较对照组低(P<0.05);术后1个月、3个月两组患者糖脂代谢指标FPG、HbAlc、TG、TC水平及BMI间差异无统计学意义(P>0.05);术后3个月观察组患者CS评分较对照组高(P<0.05);两组并发症总发生率差异无统计学意义(P>0.05)。

结论

比基尼线切口入路与常规切口入路行LSG均是肥胖症合并T2DM安全有效的治疗方式,可促进糖脂代谢,减轻患者体重,但前者能减轻组织损伤,促进患者术后早期恢复,切口美观效果更显著。

Objective

To explore the application value of different approaches of laparoscopic sleeve gastrectomy ( LSG ) in the treatment of obesity patients with type 2 diabetes mellitus ( T2DM ).

Methods

The data of 158 obese patients with T2 DM who underwent LSG from January 2021 to January 2023 were retrospectively analyzed. They were divided into two groups according to different surgical approaches, with 79 cases in each group. The observation group was treated with bikini line incision approach, and the control group was treated with routine incision. SPSS 22.0 statistical software package was used for data analysis. Measurement data such as perioperative related indicators, inflammatory stress indicators[ norepinephrine ( NE ), cortisol ( COR ), C-reactive protein ( CRP ), interleukin ( IL-6 ) ], glucose and lipid metabolism indicators[ fasting blood glucose ( FPG ), glycosylated hemoglobin ( HbA1c ), triglyceride ( TG ), total cholesterol ( TC ) ], body mass index ( BMI ) and incision aesthetic satisfaction ( CS ) scores were expressed as (), and independent t test. The number of additional holes and complications of the count data were expressed as a percentage, and the χ2 test was used. P < 0.05 indicated that the difference was statistically significant. P < 0.05 indicated that the difference was statistically significant. The baseline data of the two groups were collected. The operation and postoperative recovery indexes, inflammatory stress indexes , glucose and lipid metabolism indexes, body mass index ( BMI ) before and after surgery and cosmetic score ( CS ) , complications were observed.

Results

The number of additional holes in the observation group was less than that in the control group, and the postoperative exhaust time and hospitalization days were shorter than those in the control group ( P < 0.05 ). The levels of serum COR, NE, CRP and IL-6 in the observation group were lower than those in the control group at 1 d and 3 d after operation ( P < 0.05 ). There was no significant difference in FPG, HbAlc, TG, TC and BMI between the two groups at 1 month and 3 months after operation ( P > 0.05 ). The CS score of the observation group was higher than that of the control group at 3 months after operation ( P < 0.05 ). There was no significant difference in the total incidence of complications between the two groups ( P > 0.05 ).

Conclusion

Both the bikini line incision approach and the conventional incision approach for LSG are safe and effective treatments for obesity with T2DM, which can promote glucose and lipid metabolism and reduce the weight of patients. However, the former can reduce tissue damage and promote early postoperative recovery, and the incision is more beautiful.

表1 肥胖症合并T2DM 行LSG两组不同手术入路患者基线资料比较
表2 肥胖症合并T2DM 行LSG 两组不同手术入路患者围手术期相关指标比较
表3 肥胖症合并T2DM行LSG两种手术入路患者不同时间炎症应激指标比较()
表4 肥胖症合并T2DM 行LSG两种手术入路患者不同时间点糖脂代谢指标比较()
表5 肥胖症合并T2DM 行LSG两组患者不同时间点BMI与切口美观度比较()
表6 肥胖症合并T2DM行LSG两组手术入路患者并发症总发生率比较(例)
[1]
高晶晶,高艳虹.早发2型糖尿病流行病学、临床特征及病因机制的研究进展[J].内科理论与实践,2022,17(04):344-348.
[2]
Choi JHCho YJKim HJ,et al. Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity,Type 2 Diabetes Mellitus,and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity,Korean Diabetes Association,and Korean Society of Hypertension[J].Diabetes Metab J,2022,46(3):355-376.
[3]
孙永胜,李永帅,赵英杰,等.腹腔镜袖状胃切除术和胃旁路术治疗肥胖合并2型糖尿病近期疗效的对比研究[J].现代生物医学进展,2021,21(22):4321-4325.
[4]
孙龙和,钱春华.腹腔镜袖状胃切除术治疗肥胖症合并2型糖尿病的临床效果[J].腹腔镜外科杂志,2022,27(04):241-245.
[5]
桑伟林,薛松,朱力波,等.比基尼切口微创髋关节置换术治疗髋关节发育不良的临床疗效[J].生物骨科材料与临床研究,2021,18(03):36-41.
[6]
Danys DSikarske APoskus T. Bikini Line Sleeve Gastrectomy: the First Experience in Europe[J]. Obes Surg2021,31(7):3320-3323.
[7]
中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.肥胖症基层诊疗指南(2019年)[J].中华全科医师杂志2020,19(02):95-101.
[8]
中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.2型糖尿病基层诊疗指南(实践版·2019)[J].中华全科医师杂志,2019,18(09):810-818.
[9]
王秀娟,任益平.单孔腹腔镜下'棒球缝合法'在子宫肌瘤剥除术中的应用价值[J].医学临床研究,2021,38(06):949-951.
[10]
玉苏普江·伊明江,伊尔潘江·库尔班,马永斌,等. 腹腔镜袖状胃切除术治疗超级肥胖症的疗效与评价[J].腹腔镜外科杂志,2022,27(07):495-500.
[11]
吾慧瑛,孙心红,王惠兰.会阴侧切切口感染危险因素及对患者Th1/Th2细胞因子水平的影响[J].中华医院感染学杂志,2020,30(07):1039-1042.
[12]
陈文辉,杨华,卞景愿,等.经剖腹产瘢痕或比基尼线切口入路在腹腔镜袖状胃切除术中的应用价值[J].中华消化外科杂志,2019,18(09):848-853.
[13]
Hill AClasen KCWendt S,et al. Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis[J].Nutrients,2019,11(9):2103.
[14]
冯涛,詹兴云,林斯锋. 三种不同入路在腹腔镜解剖性肝切除术中的应用价值回顾性分析[J/CD].中华普外科手术学杂志(电子版),2022,16(01):72-75.
[15]
Wang KWu MXu J,et al. Effects of dexmedetomidine on perioperative stress,inflammation,and immune function: systematic review and meta-analysis[J].Br J Anaesth,2019,123(6):777-794.
[16]
陈伟平,黄君,芦灵军,等. 进展期胃癌患者腹腔镜与开腹胃癌D2根治术前后氧化应激、T细胞及炎症因子变化比较[J/CD].中华普外科手术学杂志(电子版),2020,14(06):562-565.
[1] 曹雯佳, 刘学兵, 罗安果, 钟释敏, 邓岚, 王玉琳, 李赵欢. 超声矢量血流成像对2型糖尿病患者颈动脉壁剪切应力的研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 709-717.
[2] 向韵, 卢游, 杨凡. 全氟及多氟烷基化合物暴露与儿童肥胖症相关性研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 569-574.
[3] 陈嘉婷, 杜美君, 石冰, 黄汉尧. 母体系统性疾病对新生儿唇腭裂发生的影响[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(04): 262-268.
[4] 孟令凯, 李大勇, 王宁, 王桂明, 张炳南, 李若彤, 潘立峰. 袖状胃切除术对肥胖伴2型糖尿病大鼠的作用及机制研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 638-642.
[5] 李猛, 姜腊, 董磊, 吴情, 贾犇黎. 腹腔镜胃袖状切除术治疗肥胖合并2型糖尿病及脂肪胰的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 554-557.
[6] 杨波, 胡旭, 何金艳, 谢铭. 腹腔镜袖状胃切除术管胃固定研究现状[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 452-455.
[7] 吉顺富, 汤晓燕, 徐进. 腹腔镜近端胃癌根治术中拓展胃后间隙在肥胖患者中的应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 393-396.
[8] 玉素江·图荪托合提, 韩琦, 麦麦提艾力·麦麦提明, 黄旭东, 王浩, 克力木·阿不都热依木, 艾克拜尔·艾力. 腹腔镜袖状胃切除或联合食管裂孔疝修补术对肥胖症合并胃食管反流病的中期疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 501-506.
[9] 刘见, 杨晓波, 何均健, 等. 应用电钩三孔法腹腔镜袖状胃切除术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(06): 363-364.
[10] 王璇, 娜扎开提·尼加提, 雒洋洋, 蒋升. 皮肤晚期糖基化终末产物浓度与2型糖尿病微血管并发症的相关性[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 447-454.
[11] 王星, 陈园, 热孜万古丽·乌斯曼, 郭艳英. T2DM、Obesity、NASH、PCOS共同致病因素相关的分子机制[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 481-490.
[12] 中国医师协会外科医师分会肥胖代谢病综合管理与护理专家工作组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国肥胖代谢外科研究协作组. 肥胖代谢外科医学科普中国专家共识(2024 版)[J/OL]. 中华肥胖与代谢病电子杂志, 2024, 10(04): 227-234.
[13] 吴晓明, 翟仰魁, 王娟, 张硕, 许杰, 潘从清. 男性2 型糖尿病患者空腹C 肽和定量胰岛素敏感性检测指数与血浆致动脉粥样硬化指数的相关性[J/OL]. 中华肥胖与代谢病电子杂志, 2024, 10(04): 288-294.
[14] 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会胃食管反流疾病诊疗外科专家工作组, 日本肥胖治疗学会, 韩国减重与代谢外科学会. 袖状胃切除术患者胃食管反流病诊治专家共识(2024版)[J/OL]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 145-162.
[15] 张梅, 陈卉, 李转霞, 王瑞, 李林娟. Metrnl和NLRP3炎症小体:糖尿病肾病的潜在诊断标志物[J/OL]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 193-199.
阅读次数
全文


摘要