腹腔镜袖状胃切除术治疗男女肥胖症疗效差异分析:历史性队列研究  

Therapeutic effect comparison of laparoscopic sleeve gastrectomy in treatment of obese males and females:a historical cohort analysis

作　　者：李浩天 朱孝成 姚立彬 洪健 邵永 LI Haotian;ZHU Xiaocheng;YAO Libin;HONG Jian;SHAO Yong(Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221004,P.R.China;Department of Gastrointestinal Surgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,P.R.China)

机构地区：[1]徐州医科大学研究生院,江苏徐州221004 [2]徐州医科大学附属医院胃肠外科,江苏徐州221002

出　　处：《中国普外基础与临床杂志》2023年第3期273-278,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：徐州医科大学附属医院发展基金面上项目(项目编号:XYFM2021023)。

摘　　要：目的比较男性和女性肥胖患者行腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)后的减重及代谢改善效果差异。方法按照纳入和排除标准,回顾性收集徐州医科大学附属医院减重代谢外科2020年1月至2021年6月期间行LSG且具有完整术前和术后第1、3、6、12个月时的随访数据的患者,比较男性和女性肥胖患者的减重及代谢改善效果以及术后第12个月时的糖尿病和高血脂缓解情况。方法本研究最终纳入符合条件的肥胖患者129例,其中男性44例、女性85例。男性肥胖患者术前的体质量指数、空腹血糖水平及胰岛素水平均高于女性肥胖患者(P<0.05)。①LSG后的减重效果:无论是男性肥胖患者还是女性肥胖患者,在观察时间范围内,体质量指数变化值(本研究中所有指标的变化值均为术前与术后的差值)、多余体质量减少百分比和总体质量减少百分比均呈持续上升趋势(P<0.05);在术后第1、3个月时男性患者体质量指数变化值高于女性患者且差异有统计学意义(P<0.05),在术后第3、6、12个月时男性患者多余体质量减少百分比低于女性患者(P<0.05)。②LSG后的代谢改善效果:无论是男性患者还是女性患者,血糖和血脂代谢指标(ΔFBG、ΔINS、ΔHbA1c、ΔTC和ΔTG)术后1个月时变化最快,3个月后变化趋平,且除了男性ΔTC(P>0.05)指标外,男女患者在术后各时点总体比较差异均有统计学意义(P<0.05);术后男性患者的空腹血糖(第1、3、6、12个月)和胰岛素(第3、6、12个月)变化值高于女性患者(P<0.05)。男性和女性患者在术后第12个月时糖尿病缓解率和高血脂缓解率均较高但2组间比较差异无统计学意义[64.7%(11/17)比81.0%(17/21),χ2=0.578,P=0.447;73.9%(17/23)比84.4%(27/32),χ2=0.378,P=0.539]。结论从本研究结果看,LSG是一种有效的治疗肥胖及其相关并发症的方法,对男女肥胖患者都有较好的治疗效果,可对代谢状态较差的男性Objective To compared weight loss and metabolic improvement effects of laparoscopic sleeve gastrectomy(LSG)in treatment of obese males and females.Methods According to the inclusion and exclusion criteria,the obese patients were retrospectively collected,who underwent LSG from January 2020 to June 2021 in the Affiliated Hospital of Xuzhou Medical University,and there were complete preoperative data and postoperative follow-up data at month 1,3,6,and 12.The weight loss and metabolic improvement effects of obese males and females were compared,as well as the remissions of diabetes and hyperlipidemia at the 12th month after surgery were observed.Results A total of 129 eligible obese patients were included,including 44 obese males and 85 obese females.The preoperative body mass index(BMI),fasting blood glucose(FBG)level,and insulin level of the obese males were higher than those of the obese females(P<0.05).①Weight loss effect after LSG:For both obese males and females,the change value(Δ)of BMI(all change values of the indexes were the difference between preoperative and postoperative value in this study),the percentage of excess body weight loss(EWL%),and percentage of total body weight loss showed continuous upward trends within the observation time range(P<0.05).And it was found that the obese males’ΔBMI was higher than that of the obese females at the 1st and 3rd month after surgery(P<0.05),and the EWL%of the obese males was lower than that of the obese females at the 3rd,6th,and 12th month after operation(P<0.05).②Metabolic improvement effect after LSG:Blood glucose and lipid metabolism indicators in both male and female patients(ΔFBG,ΔINS,ΔHbA1c,ΔTC andΔTG)changed the fastest at 1 month after operation,and the change became flat after 3 months,except for malesΔTC index(P>0.05),the overall difference between male and female patients at each time point after operation was statistically significant(P<0.05).After operation,theΔFBG(at the 1st,3rd,6th,and 12th month)andΔinsulin(at the 3rd,6th,and 12th

关 键 词：肥胖 性别 腹腔镜袖状胃切除术 临床疗效 

分 类 号：R656.61[医药卫生—外科学]