腹腔镜袖状胃切除术和Roux-en-Y胃旁路术后内生化环境与术后并发症的关系  

Relationship between endobiochemical environment and postoperative complications after laparo-scopic sleeve gastrectomy and Roux-en-Y gastric

作　　者：谷敬锋[1] 王桂琦[1] 刘海霞 冯峰 张建 邢东洋 高昊雯 Gu Jingfeng;Wang Guiqi;Liu Haixid;Feng Feng;Zhang Jian;Xing Dongyang;Gao Haowen(Department of Bariatric and Metabolic Surgery,the First Hospital of Hebei Medical University,Shijiazhuang050011,China;Department of General Surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第一医院减重与代谢外科,石家庄050011 [2]河北医科大学第一医院普外科,石家庄050011

出　　处：《中华实验外科杂志》2024年第7期1558-1561,共4页Chinese Journal of Experimental Surgery

摘　　要：目的探讨腹腔镜袖状胃切除术(LSG)和Roux-en-Y胃旁路术(LRYGB)术后内生化环境与术后并发症关系。方法选择2020年1月至2022年12月在河北医科大学第一医院行LSG和LRYGB的患者200例, 其中行LSG 141例, 行LRYGB 59例。随访半年, 以手术后30 d内是否发生并发症分为并发症组和非并发症组, 采用t检验、χ^(2)检验比较两组临床资料、内生化指标, 并应用二元Logistic回归分析术后并发症危险因素, 构建其预测模型, 受试者工作特征(ROC)曲线分析模型的预测效能, Hosmer-Lemeshow检验评价模型的拟合优度。结果并发症组高血压发生率[34.62%(9/26)比17.24%(30/174)]、内脏肥胖发生率[96.15%(25/26)比75.86%(132/174)]高于非并发症组(χ^(2)=4.350、5.519, P<0.05), CD3^(+)[(43.23±5.75)%比(51.53±6.04)%]、CD4^(+)/CD8^(+)(1.19±0.25比1.42±0.27)低于无并发症组(t=-6.575、55.864, P<0.05), 血乳酸[(0.73±0.33) mmol/L比(0.59±0.21) mmol/L]高于无并发症组(t=2.920, P<0.05)。经Logistic回归分析, 高CD3^(+)、高CD4^(+)/CD8^(+)是术后并发症的保护因素[比值比(OR)=0.602, 95%可信区间(CI):0.452~0.803, P<0.05;OR=0.002, 95%CI:0.000~0.145, P<0.05], 高血乳酸是其危险因素(OR=1 831 920.488, 95%CI:1 875.614~1 789 245 268.000, P<0.01)。Hosmer-Lemeshow检验显示, 模型的预测值与实际观测值之间差异无统计学意义, 模型拟合优度较好(χ^(2)=2.381, P>0.05)。ROC分析显示, 评价模型的曲线下面积(AUC)为0.664。结论术后内生化环境构建的模型对术后并发症具有较高预测价值。Objective To investigate the relationship between the endobiochemical environment and postoperative complications after laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(LRYGB).Methods A total of 200 patients received LSG and LRYCB from the First Hospital of Hebei Medical University from January 2020 to December 2022,including 141 patients receiving LSG and 59 pa-tients receiving LRYGB.The patients were followed up for half a year and divided into complication group and non-complication group according to whether complications occurred within 30 days after operation.T test and χ^(2) test were used to compare clinical data and endobiochemical indexes of the two groups,and the risk factors of postoperative complications were analyzed by binary Logistic regression,and the prediction model was constructed.The predictive efficiency of the model was analyzed by receiver operating character-istic(ROC)curve.Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.Results The incidence of hypertension[34.62%(9/26)vs.17.24%(30/174)]and visceral obesity[96.15%(25/26)vs.75.86%(132/174)]in the complication group was higher than that in the non-complication group(χ^(2)=4.350,5.519,P<0.05).CD3^(+)[(43.23±5.75)%vs.(51.53±6.04)%]and CD4^(+)/CD8^(+)(1.19±0.25 vs.1.42±0.27)in the complication group were lower than those in the non-complication group(t=-6.575,55.864,P<0.05).Blood lactic acid[(0.73±0.33)vs.(0.59±0.21)mmol/L)in the complication group was higher than that in the non-complication group(t=2.920,P<0.05].Logis-tic regression analysis showed that high CD3^(+)and CD4^(+)/CD8^(+)rate was the protective factor for postopera-tive complications[odds ratio(OR)=0.602,95%confidence interval(CI):0.452-0.803,P<0.05;OR=0.002,95%CI:0.000-0.145,P<0.05],and high blood lactic acid was the risk factor(OR=1831920.488,95%CI:1875.614-1789245268.000,P<0.01).Hosmer-Lemeshow test showed that χ^(2)=2.38i.>0.05.and themodel had godgodnesoft.ROcanalyishowed hat hearade curve(AUC)of the evaluation model was

关 键 词：腹腔镜袖状胃切除术 ROUX-EN-Y胃旁路术 并发症 

分 类 号：R656.61[医药卫生—外科学]