腹腔镜袖状胃切除术治疗肥胖症及其合并症的疗效分析  

Effectiveness of Laparoscopic Sleeve Gastrectomy in Treating Obesity and Its Co-morbidities

作　　者：李子建[1] 于健春[1] 康维明[1] 马志强[1] 叶欣[1] 朱惠娟[2] 于康[3] 陈伟[3] 刘燕萍[3] 李涛[4] 肖毅[5] 罗金梅[5] 张抒扬[6] LI Zijian;YU Jianchun;KANG Weiming;MA Zhiqiang;YE Xin;ZHU Huijuan;YU Kang;CHEN Wei;LIU Yanping;LI Tao;XIAO Yi;LUO Jinmei;ZHANG Shuyang(Department of General Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Department of Endocrinology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Department of Nutrition,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Department of Psychology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Department of Respiratory Medicine,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Department of Cardiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院基本外科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院内分泌科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院营养科,北京100730 [4]中国医学科学院北京协和医学院北京协和医院心理科,北京100730 [5]中国医学科学院北京协和医学院北京协和医院呼吸内科,北京100730 [6]中国医学科学院北京协和医学院北京协和医院心内科,北京100730

出　　处：《中国医学科学院学报》2018年第5期610-616,共7页Acta Academiae Medicinae Sinicae

摘　　要：目的总结腹腔镜袖状胃切除术(LSG)后的长期减重效果及合并症改善情况,评估手术安全性。方法回顾性分析2012年8月至2017年8月在北京协和医院基本外科行LSG手术的病态肥胖患者的临床资料,总结术后长期有效率即减重效果[多余体质量减轻百分比(%EWL)]及合并症改善情况,评估围手术期和术后远期并发症的发生情况。结果共75例肥胖患者完成LSG,男28例,平均体质量指数(BMI)(47. 3±7. 5) kg/m2;女47例,平均BMI (41. 1±7. 0) kg/m2。常见合并症是肝功异常(53. 3%)、血脂异常(52. 0%)、阻塞性睡眠呼吸暂停(45. 3%)、2型糖尿病(38. 7%)和高血压(37. 3%),术后3年缓解率分别是75. 0%、58. 3%、83. 3%、75. 0%和58. 3%。术后1、2、3年的平均%EWL分别是81. 6±34. 7、80. 9±30. 2、79. 7±30. 8;达到成功减重(%EWL> 50%)的比例分别为81. 7%(n=49)、81. 0%(n=34)、79. 3%(n=23)。术后近期严重并发症(Clavien-Dindo分级>Ⅱ级)发生率为2. 6%;远期并发症中轻度胃食管反流最多(8%),口服抑酸剂可缓解。结论 LSG可在术后长期有效减轻中国肥胖患者的体质量,改善其合并症;手术本身相对安全,值得推广。Objective To analyze the effectiveness and safety of laparoscopic sleeve gastrectomy(LSG)in treating obesity and its co-morbidities.Methods The clinical data of obese patients undergoing LSG in Peking Union Medical College Hospital from August 2012 to August 2017 were retrospectively analyzed.Medium-term outcome measures included excess weight loss(%EWL),co-morbidity improvement,and complications.Results Seventy-five obese patients comprising 28 men[body mass index(BMI):(47.3±7.5)kg/m 2)]and 47 women were enrolled in this analysis.The common co-morbidities were liver dysfunction(53.3%),dyslipidemia(52.0%),obstructive sleep apnea(45.3%),type 2 diabetes mellitus(38.7%),and arterial hypertension(37.3%),which were improved by 75.0%,58.3%,83.3%,75.0%and 58.3%three years after surgery.The mean%EWL at 1,2,and 3 years after surgery was 81.6±34.7,80.9±30.2 and 79.7±30.8,respectively.The proportions of patients achieving successful weight loss were 81.7%(n=49),81.0%(n=34),and 79.3%(n=23)at 1,2,and 3 years(%EWL>50%).Early severe complications(Clavien-Dindo classification>Ⅱ)occurred in 2.6%of patients,and the most common late complications was gastroesophageal reflux disease,which could be relieved by acid suppressants.Conclusion LSG is effective and safe in treating obesity and its co-morbidities.

关 键 词：肥胖症 腹腔镜袖状胃切除术 长期减重 合并症改善 并发症 

分 类 号：R619[医药卫生—外科学] R723.14[医药卫生—临床医学]