袖状胃切除术、Roux-en-Y胃旁路术、单吻合口十二指肠回肠旁路联合袖状胃切除术和胆胰转流十二指肠转位术治疗超级肥胖患者的一年疗效分析  

Analysis of the 1-year curative efficacy of sleeve gastrectomy, Roux-en-Y gastric bypass, single anastomosis duodenal-ileal bypass with sleeve gastrectomy and biliopancreatic diversion with duodenal switch in patients with super obesity

作　　者：张峥 王伦 赵玉会 姜涛[1] 张忠正 王侠 胡力夫 肖明昊 Zhang Zheng;Wang Lun;Zhao Yuhui;Jiang Tao;Zhang Zhongzheng;Wang Xia;Hu Lifu;Xiao Minghao(Department of Bariatric and Metabolic Surgery,China-Japan Union Hospital,Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院减重与代谢外科,长春130033

出　　处：《中华胃肠外科杂志》2023年第9期859-865,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：吉林省科学与技术项目(20180101163JC)。

摘　　要：目的评估袖状胃切除术(SG)、Roux-en-Y胃旁路术(RYGB)、单吻合口十二指肠回肠旁路联合袖状胃切除术(SADI-S)和胆胰转流十二指肠转位术(BPD/DS)等4种减重术式治疗超级肥胖患者术后1年的疗效。方法采用回顾性观察性研究,收集2015年11月至2020年12月期间在吉林大学中日联谊医院接受减重手术治疗的40例超级肥胖症[体质指数(BMI)≥50 kg/m^(2)]患者的临床资料,全组男性21例,女性19例,年龄(31.7±9.0)岁,术前体质量和BMI分别为(159.2±16.9)kg和(53.4±3.0)kg/m^(2)。术前合并高血压30例,高尿酸血症27例,2型糖尿病15例,总胆固醇异常升高10例,甘油三酯异常升高20例,低密度脂蛋白异常升高24例。根据减重术式的不同分为SG组(16例)、RYGB组(9例)、SADI-S组(9例)和BPD/DS组(6例)。观察术后3、6和12个月的体质量、体质指数、多余体质量减少百分比(%EWL)、总体质量减少百分比(%TWL)、术前合并的代谢性疾病(包括高血压、高尿酸血症、2型糖尿病、高脂血症等;其中高血压观察指标为收缩压和舒张压;2型糖尿病观察指标为糖化血红蛋白;高脂血症观察指标为总胆固醇、甘油三酯和低密度脂蛋白)在术后1年的缓解情况以及手术安全性。结果所有患者均顺利完成腹腔镜减重手术,无一例中转开腹。术中失血量均不足50 ml,术后住院时间6~16 d。全组均无围手术期死亡病例;除RYGB组有2例出现术后并发症,分别为出血和吻合口漏,其余各组均未发生并发症。4组患者在术后3、6和12个月的体质量和BMI与术前相比均下降,差异均有统计学意义(均P<0.05);术后3、6和12个月时,SG组%EWL分别为36.6±11.0、62.4±15.7和68.2±16.0(F=21.830,P<0.001);RYGB组分别为30.6±6.9、42.5±5.8和50.6±11.1(F=13.222,P<0.001);SADI-S组分别为39.7±7.8、54.6±12.7和81.9±12.0(F=33.821,P<0.001);BPD/DS组分别为40.2±4.8、57.7±11.8和82.8±14.9(F=21.552,P<0.001),均呈现逐渐增加的趋势,差异均Objective To evaluate the 1-year postoperative efficacy of four bariatric procedures,namely sleeve gastrectomy(SG),Roux-en-Y gastric bypass(RYGB),single anastomosis duodenal-ileal bypass with sleeve gastrectomy(SADI-S),and biliopancreatic diversion with duodenal switch(BPD/DS)for treating super obesity.Methods In this retrospective observational study,we analyzed the clinical data of 40 patients with super obesity(body mass index[BMI]≥50 kg/m^(2))who had undergone bariatric surgery in the China-Japan Union Hospital of Jilin University from November 2015 to December 2020.The study cohort consisted of 21 men and 19 women of average age 31.7±9.0 years.The preoperative weight and BMI were(159.2±16.9)kg and(53.4±3.0)kg/m^(2),respectively.Prior to the surgery,30 individuals had hypertension,27 hyperuricemia,15 type 2 diabetes,10 abnormally high total cholesterol,20 abnormally high triglycerides,and 24 abnormally high low-density lipoprotein.We divided the participants into four groups according to the type of operation:SG group(n=16),RYGB group(n=9),SADI-S group(n=9)and BPD/DS group(n=6).We examined the following factors:weight,BMI,excess weight loss(%),total weight loss(%),and remission of preoperative metabolic diseases(including hypertension,hyperuricemia,type 2 diabetes,and hyperlipidemia)3,6,and 12 months after surgery.The variables assessed for hypertension were systolic and diastolic blood pressure;for type 2 diabetes,glycated hemoglobin;and for hyperlipidemia,total cholesterol,triglycerides,and low-density lipoprotein 1-year after the surgery.The safety of surgery was also assessed.Results All patients successfully completed laparoscopic procedures,none of them requiring conversion to laparotomy.The amount of blood loss during surgery was less than 50 mL.Postoperative hospital stay was 6-16 days.There were no deaths during the perioperative period.However,two postoperative complications occurred in the RYGB group,namely bleeding and anastomotic leakage.No complications were detected in the other groups.At

关 键 词：超级肥胖 单吻合口十二指肠回肠旁路联合袖状胃切除术 袖状胃切除术 ROUX-EN-Y胃旁路术 胆胰转流十二指肠转位术 疗效 

分 类 号：R656.61[医药卫生—外科学]