腹腔镜袖状胃切除术与Roux-en-Y胃旁路术治疗代谢综合征伴非酒精性脂肪肝患者的临床效果比较  

Comparison of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypassfor Metabolic Syndrome with Nonalcoholic Fatty Liver

作　　者：王志霞 杨慧 张卫星 WANG Zhixia;YANG Hui;ZHANG Weixing(Department of General Surgery,Central Hospital of Jiaozuo Coal Industry(Group)Co.,LTD,Jiaozuo 454000,China)

机构地区：[1]焦作煤业(集团)有限责任公司中央医院普通外科,河南焦作454000

出　　处：《河南医学研究》2024年第18期3391-3395,共5页Henan Medical Research

摘　　要：目的比较腹腔镜袖状胃切除术(LSG)、Roux-en-Y胃旁路术(LRYGB)治疗代谢综合征(MS)伴非酒精性脂肪肝(NAFLD)的效果。方法前瞻性分析2021年4月至2022年10月焦作煤业(集团)有限责任公司中央医院收治的200例MS伴NAFLD患者,随机分为LRYGB组(腹腔镜LRYGB术)和LSG组(腹腔镜LSG术),各100例。比较两组手术指标、术后并发症、术前及术后6、12个月糖代谢指标[空腹血糖水平(FBG)、糖化血红蛋白水平(HbA1c)、胰岛素抵抗指数(HOMA-IR)]、脂代谢指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)]、减重情况[体重、体重指数(BMI)]、NAFLD病情控制情况。结果LSG组术中总失血量少于LRYGB组,手术用时、术后进食流食时间、术后初次排气时间、住院天数均短于LRYGB组(P<0.05),术后并发症发生率低于LRYGB组(P<0.05);术后6个月和12个月,两组LSG组HbA1c、FBG、HOMA-IR、TC、TG、LDL-C水平、体重、BMI均较术前降低,HDL-C水平均较术前升高(P<0.05),但两组间比较,差异无统计学意义(P>0.05)。术后6个月和12个月,NAFLD病情均较术前减轻,但两组NAFLD病情控制情况比较,差异无统计学意义(P>0.05)。结论LSG与LRYGB均可有效治疗MS伴NAFLD患者,可改善糖代谢指标、脂代谢指标、减重情况,有效控制NAFLD病情,但与LRYGB相比,LSG能减少术中总失血量,缩短手术用时,减少术后并发症的发生,促进术后快速恢复,在MS伴NAFLD患者治疗中更具有优势。Objective To compare the efficacy of laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(LRYGB)in the treatment of metabolic syndrome(MS)with nonalcoholic fatty liver disease(NAFLD).Methods A total of 200 patients with MS and NAFLD in Central Hospital of Jiaozuo Coal Industry(Group)Co.,LTD from April 2021 to October 2022 were prospectively selected and divided into LRYGB group and LSG group by random number table method,100 cases in each group.Surgical indicators,postoperative complications,glucose metabolism indexes[fasting blood glucose level(FBG),glycosylated hemoglobin level(HbA1c),insulin resistance index(HOMA-IR)],lipid metabolism indexes[total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C),triglyceride(TG)],weight loss[body mass,body mass index(BMI)],NAFLD disease controls before and after 6,12 months of operation were compared between two groups.Results The amount of blood loss in LSG group was less than that in LRYGB group,operation time,the time of liquid intake,the time of exhaust and the time of hospitalization were shorter than those in LRYGB group(P<0.05).The incidence of postoperative complications in LSG group was lower than that in LRYGB group(P<0.05).After 6,12 months of operation,the levels of HbA1c,FBG,HOMA-IR,TC,TG,LDL-C,body mass and BMI in LSG group in both groups were gradually decreased,the level of HDL-C was gradually increased compared with before surgery(P<0.05),but there were no significant differences in above indicators between the two groups(P>0.05).After 6,12 months of operation,the condition of NAFLD was reduced compared with before operation,but there was no statistical significance in the control of NAFLD between the two groups(P>0.05).Conclusion LSG and LRYGB are both reliable treatment options for patients with MS and NAFLD,both of which can improve glucose metabolism indexes,lipid metabolism indexes,weight loss,and effectively control the disease of NAFLD.However,compared with LRYGB,LSG can reduce intrao

关 键 词：代谢综合征 非酒精性脂肪肝 ROUX-EN-Y胃旁路术 腹腔镜袖状胃切除术 

分 类 号：R656.61[医药卫生—外科学]