超级肥胖的手术选择:袖状胃切除术+空肠空肠旁路术?  

Surgical options for super obesity:sleeve gastrectomy+jejunojejunal bypass?

作　　者：郑锐滨 周霞[1] 赵象文[1] ZHENG Ruibin;ZHOU Xia;ZHAO Xiangwen(Department of Bariatric and Metabolic Disease Surgery,Zhongshan Xiaolan People's Hospital,Zhongshan 528415,China)

机构地区：[1]中山市小榄人民医院减重与代谢病外科,广东中山528415

出　　处：《腹腔镜外科杂志》2023年第10期727-732,共6页Journal of Laparoscopic Surgery

摘　　要：目的:分析袖状胃切除术(SG)及SG+空肠空肠旁路术(JJB)治疗超级肥胖患者的疗效及安全性,探讨治疗超级肥胖的手术方式。方法:回顾性收集并分析2017年4月至2021年8月收治的27例超级肥胖患者的临床资料及术后1年随访资料,13例行SG(SG组),14例行SG+JJB(SG+JJB组),对比分析两组减重效果、代谢指标改善情况及手术安全性。结果:与术前相比,术后1年时两组患者体重、体重质量指数均降低,差异有统计学意义;SG+JJB组高密度脂蛋白胆固醇水平升高,总胆固醇、糖化血红蛋白水平下降,差异有统计学意义;SG组空腹血糖、糖化血红蛋白水平下降,高密度脂蛋白胆固醇水平升高,差异有统计学意义。两组间在减重及改善代谢指标方面差异无统计学意义。两组高血压、糖尿病治愈率均为100%。SG组手术时间短于SG+JJB组,差异有统计学意义。SG+JJB组出现1例胃漏,两组术后均未出现消化道出血、狭窄、肠梗阻。结论:SG及SG+JJB治疗超级肥胖均是安全、可行的,均能降低超级肥胖患者体重,同时可改善患者糖代谢及脂代谢,两种术式的减重效果及改善代谢性疾病效果相当,SG手术时间更短,可作为超级肥胖患者手术治疗的首选术式。Objective:To analyze the efficacy and safety of sleeve gastrectomy(SG)and SG plus jejunojejunal bypass(JJB)in the treatment of super obese patients,in order to explore the surgical method for the treatment of super obesity.Methods:The clinical data and 1-year follow-up data of super obese patients treated from Apr.2017 to Aug.2021 were retrospectively collected and analyzed.A total of 27 patients were included,of which 13 cases underwent SG,14 patients underwent SG+JJB.The effect of weight loss,improvement of metabolic indicators and surgical safety of the two groups were compared and analyzed.Results:The patients in the two groups were able to lose body weight and body mass index at 1 year after surgery,and the difference was statistically significant.During the 1-year follow-up,the levels of high-density lipoprotein cholesterol increased,while the levels of total cholesterol and glycosylated hemoglobin decreased in the SG+JJB group,and the differences were statistically significant.In the SG group,the levels of fasting blood glucose and glycosylated hemoglobin decreased,and the level of high-density lipoprotein cholesterol increased,and the difference was statistically significant.However,there was no statistical difference between two groups in terms of weight loss and improvement of metabolic indicators.The cure rate of hypertension and diabetes in both groups reached 100%.The operation time of the SG group was shorter than that of the SG+JJB group,and the difference was statistically significant.There was 1 case of gastric leak in the SG+JJB group,and there was no postoperative gastrointestinal bleeding,stricture,or intestinal obstruction occurred in the two groups.Conclusions:SG and SG+JJB are safe and feasible for the treatment of super obesity.Both of them can reduce the body weight of super obese patients and improve the glucose metabolism and lipid metabolism of patients,and the effects of weight loss and improvement of metabolic diseases are similar.The operation time of SG is shorter,and it could be u

关 键 词：超级肥胖 袖状胃切除术 空肠空肠旁路术 腹腔镜检查 疗效比较研究 安全性 

分 类 号：R656.6[医药卫生—外科学]