腹腔镜下胃袖状切除术在超级肥胖患者中减重效果及安全性分析
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首都医科大学附属北京天坛医院 普通外科,北京 100070

作者简介:

邢颖,首都医科大学附属北京天坛医院主治医师,主要从事胃肠道疾病方面的研究。

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白日星,Email: brx5168@163.com

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Weight loss efficacy and safety of laparoscopic sleeve gastrectomy in super obese patients
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Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

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    摘要:

    背景与目的 腹腔镜下胃袖状切除术(LSG)作为现阶段最常见的减重手术术式之一,其在单纯性肥胖患者中的减重效果在学术界已达成共识,但在超级肥胖患者中的应用效果尚未见大范围报道,本研究回顾性研究BMI≥50 kg/m2的超级肥胖(SO)患者接受LSG的减重效果和围术期安全性。方法 选择2017年3月—2022年6月间于首都医科大学附属北京天坛医院普通外科接受LSG的SO患者,记录手术时间、出血量、并发症情况等,以观察LSG在SO患者中的手术安全性,并分析患者接受LSG后,体质量、BMI、多余体质量减少(%EWL)、空腹血糖、肝肾功能、血脂四项、尿酸及合并症改善情况。结果 共纳入39例SO患者,男23例,女16例;平均年龄(31.15±8.37)岁;术前平均体质量(159.97±19.97)kg,BMI(54.46±3.89)kg/m2。所有患者均完善术前常规检查及腹部超声、血管超声、胃镜、超声心动图、血气分析等检查,并经过多学科会诊完成术前评估,均于腹腔镜下采用四孔法完成手术,无中转开腹患者,平均手术时间(63.00±12.30)min,术中出血(23.00±4.30)mL,1例患者于术中发现肝硬化,未合并脾功能亢进及门脉高压,术后未出现严重肝功能不全;术后无腹腔出血、二次手术、肺部感染、下肢静脉血栓及围术期死亡等情况。术后第1个月开始,患者体质量及BMI即开始出现明显下降,术后第1、3、6、12、24、36个月时%EWL分别为17.69%、38.84%、54.21%、62.09%、61.12%、57.00%;术后3个月开始,患者丙氨酸氨基转移酶、天门冬氨酸氨基转移酶水平较术前明显下降(均P<0.05);术后患者血脂4项较术前好转,其中甘油三酯、总胆固醇、低密度脂蛋白较术前降低,高密度脂蛋白较术前有所升高,在术后6、12个月时高密度脂蛋白变化有统计学差异;尿酸在术后12个月时出现明显下降(P<0.05);而肌酐及尿素氮术前术后无明显变化(均P>0.05);9例合并2型糖尿病的患者,术后糖化血红蛋白均有明显下降,1例患者术后6个月时仍需口服降糖药物;术后1年时,所有患者肝肾功能及血脂均恢复正常,12例高血压患者中仅3例仍需使用降压药物。结论 LSG在SO患者中具有较高的安全性,且减重和合并症控制效果良好,可作为此类患者的首选减重术式。

    Abstract:

    Background and Aims Laparoscopic sleeve gastrectomy (LSG) is presently one of the most common bariatric operations. Its weight-loss effect in simple obese patients has reached consensus among surgeons, but its effect in super obese (SO) patients has not been reported on a large scale. This was conducted to retrospectively investigate the weight-loss effect and perioperative safety of LSG for super-obese patients with a BMI greater than 50 kg/m2.Methods Super obese patients who received LSG in the Department of General Surgery of Beijing Tiantan Hospital Affiliated to Capital Medical University from March 2017 to June 2022 were selected. The variables such as operative time, bleeding volume, and complication were recorded, the surgical safety of LSG in super obese patients was observed, and the improvements in body weight, BMI, excess weight loss (%EWL), fasting blood glucose, liver and kidney function, blood lipid, uric acid and comorbidities after LSG were analyzed.Results A total of 39 super obese patients were included, including 23 males and 16 females, with an average age of (31.15±8.37) years, an average preoperative weight of (159.97±19.97) kg, and an average BMI of (54.46±3.89) kg/m2. In all patients, the routine preoperative examination, abdominal ultrasound, vascular ultrasound, gastroscopy, echocardiography, blood gas analysis, and other tests were completed, and preoperative evaluation through multidisciplinary consultation was made. All patients underwent a four-port laparoscopic operation without conversion to open surgery. The average operative time was (63.00±12.30) min, and the intraoperative blood loss was (23.00±4.30) mL. Cirrhosis was found in one patient during the operation, without hypersplenism and portal hypertension; there was no severe liver dysfunction, no abdominal bleeding, secondary operation, pulmonary infection, lower extremity venous thrombosis, and perioperative death after the procedure., From the first month after the operation, the weight and BMI of the patients began to decrease significantly. The %EWL at the 1st, 3rd, 6th, 12th, 24th, and 36th months after the operation was 17.69%, 38.84%, 54.21%, 62.09%, 61.12%, and 57.00%, respectively; from 3 months after the operation, alanine aminotransferase and aspartate aminotransferase decreased significantly compared with those before operation (all P<0.05); blood lipids were improved after operation, uric acid significantly reduced at 12 months after operation (P<0.05); there was no significant change of creatinine and urea nitrogen before and after the operation (both P>0.05); in 9 patients with type 2 diabetes, the glycosylated hemoglobin markedly decreased after the operation, and one patient still needed oral hypoglycemic drugs six months after operation; one year after the operation, the liver and kidney functions and blood lipids of all patients returned to normal, and only 3 of the 12 hypertensive patients still needed antihypertensive drugs.Conclusion LSG has a high safety in super obese patients and has a good effect on weight loss and comorbidity control. It can be the first weight loss surgery choice for such patients.

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邢颖,闫文貌,白日星.腹腔镜下胃袖状切除术在超级肥胖患者中减重效果及安全性分析[J].中国普通外科杂志,2022,31(10):1307-1315.
DOI:10.7659/j. issn.1005-6947.2022.10.006

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  • 收稿日期:2022-08-03
  • 最后修改日期:2022-09-11
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  • 在线发布日期: 2022-10-31