腹腔镜袖状胃切除术与胃旁路术治疗肥胖症的临床疗效观察  

The comparative study on clinical effect of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass for obesity

作　　者：蔡逊[1] 马丹丹[1] 叶家欣[1] 邵俊伟[1] 袁野[1] 

机构地区：[1]广州军区武汉总医院,湖北武汉430070

出　　处：《腹腔镜外科杂志》2015年第7期516-520,共5页Journal of Laparoscopic Surgery

基　　金：湖北省自然科学基金资助项目(编号:2010CDB09201)

摘　　要：目的:观察腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)及腹腔镜胃转流术(laparoscopic gastric bypass,LGBP)治疗肥胖症及其并发症的可行性与手术疗效。方法:回顾分析2011年1月至2013年12月20例接受LSG治疗及28例接受LGBP治疗的肥胖症患者的临床资料,观察减重效果及其并发症改善情况。结果:48例手术均在腹腔镜下顺利完成,无术中并发症发生及中转开腹。术后随访1年,LSG组与LGBP组的体重指数[LSG:(24.40±1.46)kg/m2,LGBP:(24.50±1.37)kg/m2]均较术前[LSG:(35.44±2.62)kg/m2,LGBP:(34.18±2.36)kg/m2]显著降低(LSG:t=19.654,P=0.000;LGBP:t=16.620,P=0.000)。2组患者高脂血症、高血压、胃食管反流性疾病、阻塞性睡眠呼吸暂停综合征及2型糖尿病等肥胖相关并发症发生率显著降低(P<0.05)。结论:LSG与LGBP治疗肥胖症及其并发症是安全、有效、切实可行的。单纯性肥胖症患者宜采用LSG治疗,合并2型糖尿病的肥胖症患者宜采用LGBP治疗。Objective：To observe the feasibility and efficacy of laparoscopic sleeve gastrectomy （LSG） and laparoscopic gastric bypass （LGBP） for patients with obesity and obesity-related comorbidities. Methods：Clinical data of 20 obesity patients who underwent LSG and 28 obese type 2 diabetes mellitus patients who underwent LGBP from Jan. 2011 to Dec. 2013 were retrospectively analyzed. The effect of weight reduction and improvement of complication were observed. Results ： The procedure was completed in all the patients without intraoperative complications or conversion to open surgery. One year after the operation, the mean BMI of the patients in LSG group significantly dropped from （ 35.44 ± 2.62 ） kg/m2 to （ 24.40 - 1.46 ） kg/m2 （ t = 19. 654, P = 0. 000 ）. Meanwhile, the mean BMI of the patients in LGBP group significantly decreased from （34.18 ± 2.36） kg/m2 to （24.50 ± 1.37） kg/m2 （ t = 16. 620, P = 0. 000）. Moreover, the obesity-related comorbidities in 2 groups included hyperlipemia, hypertension, gastroesophageal reflux disease, obstructive sleep apnea syndrome and type 2 diabetes mellitus were significantly decreased （ P 〈 0.05 ）. Conclusions ： LSG and LGBP are safe, effective and feasible options for the treatment of obesity. LSG is effective for simple obesity while LGBP is effective for obesity with type 2 diabetes mellitus.

关 键 词：肥胖症 腹腔镜检查 袖状胃切除术 胃旁路术 治疗结果 

分 类 号：R656.6[医药卫生—外科学]