减重代谢手术对肥胖型多囊卵巢综合征的治疗效果评价  

Evaluations of efficacy of metabolic and bariatric surgery in obese patient with polycystic ovary syndrome

作　　者：王清波 屈兵 罗建飞[1] Wang Qingbo;Qu Bing;Luo Jianfei(Department II of Gastrointestinal Surgery,Renmin Hospital of Wuhan University,Hubei Wuhan 430060,China)

机构地区：[1]武汉大学人民医院胃肠外二科,湖北武汉430060

出　　处：《腹部外科》2024年第5期343-347,355,共6页Journal of Abdominal Surgery

基　　金：湖北省微循环学会科研资助基金[HBWXH 2022(1)-1]。

摘　　要：目的探讨不同类型减重代谢手术对肥胖伴多囊卵巢综合征(polycystic ovary syndrome,PCOS)病人体重、体重指数(body mass index,BMI)、卵巢形态学、卵泡数量、月经周期、雄激素及抗苗勒管激素(anti-mullerian hormone,AMH)分泌水平的改善效果。方法选取2021年2月至2023年6月武汉大学人民医院胃肠外二科收治的70例肥胖伴PCOS病人及60例肥胖不伴PCOS病人,根据手术方式,将肥胖伴PCOS病人分为胃袖状切除术组(sleeve gastrectomy,SG)和Roux-enY胃旁路术组(Roux-en-Y gastric bypass,RYGB),各35例;肥胖不伴PCOS病人60例分为SG组和RYGB组,各30例。对各组手术病人进行观察,分析其体重、BMI、卵巢形态学、卵泡数量、月经周期、雄激素及AMH水平的变化情况。结果两组肥胖伴PCOS病人术后体重、BMI均显著低于术前(均P<0.05);卵巢体积显著缩小、卵泡数量显著减少、月经周期显著缩短(均P<0.05);AMH和雄激素水平均显著低于术前(均P<0.05)。减重代谢手术(SG及RYGB)对PCOS及非PCOS肥胖病人均有显著减重作用,且减重效果差异无统计学意义(P>0.05)。RYGB在远期减重、长期调节卵巢卵体积及泡数量、长期改善雄激素水平、短期内调整月经周期及降低AMH水平等方面优于SG(均P<0.05)。结论减重代谢手术(SG/RYGB)在减轻体重的同时也可显著缓解肥胖伴发的PCOS。Objective To explore the effects of different types of metabolic and bariatric surgery on body weight(BW),body mass index(BMI),ovarian morphology,follicle number,menstrual cycle,androgens and anti-mullerian hormone(AMH)in obese patients with polycystic ovary syndrome(PCOS).Methods From February 2021 to June 2023,70 obese patients with PCOS and 60 obese patients without PCOS admitted were assigned into two groups.For obese patients with PCOS,sleeve gastrectomy(SG,n=35)and Roux-en-Y gastric bypass(RYGB,n=35)were performed.And for obese patients without PCOS,SG(n=30)and RYGB(n=30)were performed.The changes of BW,BMI,ovarian morphology,follicle number,menstrual cycle and androgen/AMH level of two groups were recorded.Results BW and BMI at post-operation were significantly lower than those at preoperation.Ovarian volume and follicle number declined markedly,menstrual cycle became obviously shortened and AMH/androgen level dropped significantly as compared with those at pre-operation.SG/RYGB demonstrated marked weight loss in both PCOS and non-PCOS obese patients and no significant difference existed in weight loss effect.And RYGB was superior to SG in long-term weight loss,longterm regulation of follicle volume/quantity,long-term improvement of androgen level,short-term adjustment of menstrual cycle and lowering the level of AMH.Conclusion SG/RYGB may significantly relieve PCOS in obese patients.

关 键 词：胃袖状切除术 ROUX-EN-Y胃旁路术 肥胖 多囊卵巢综合征 

分 类 号：R605[医药卫生—外科学] R656[医药卫生—临床医学]