腹腔镜袖状胃切除术治疗代谢综合征50例疗效分析(两年随访)
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摘要
目的探讨腹腔镜袖状胃切除术(LSG)治疗代谢综合征的安全性和有效性。方法回顾性分析2013年2月至2017年6月在解放军第一五三中心医院接受腹腔镜袖状胃切除手术的50例患者临床资料,记录并比较术前及术后1个月、3个月、6个月、1年、2年的体质量、体质量指数(BMI)、平均动脉压、血清甘油三脂、高密度脂蛋白、空腹血糖(FPG)、糖化血红蛋白(HbA1c)及糖尿病、高血压、高脂血症、睡眠呼吸暂停综合征、脂肪肝、关节退行性变改善情况。结果 50例患者均顺利完成LSG,手术时间(70.7±26.3) min,术后住院时间(7.0±1.7) d。所有患者术后随访时间均超过2年,无围手术期死亡及术后严重并发症发生,体质量、BMI在术后3个月可观察到明显下降(P<0.05);24例合并高血压,平均动脉压在术后1个月出现明显下降然后保持相对稳定(P<0.05),术后两年内高血压完全缓解率63%;35例合并高甘油三脂血症,血清甘油三酯在术后6个月出现明显下降(P<0.05),而高密度脂蛋白在术后1年出现有统计学意义的升高(P<0.05);32例合并糖尿病,FPG在术后1个月出现明显下降(P<0.05),HbA1c同样在术后1个月出现明显下降(P<0.05),其中12例完全治愈而且不需进行药物治疗,治愈率为37.5%。术后2年内患者脂肪肝、睡眠呼吸暂停及关节退行性变也得到不同程度的改善。结论 LSG治疗肥胖症安全性好、效果显著,在明显减轻体重的同时还能治愈或显著改善其合并的代谢综合征。
Objective To estimate the effect and safety of laparoscopic sleeve gastrectomy for metabolic syndrome. Methods Clinical data of 50 patients accepting laparoscopic sleeve gastrectomy were analyzed retrospectively. Body mass, body mass index(BMI), mean arterial pressure, serum triglyceride, high density lipoproteins, fasting plasma glucose,glycosylated hemoglobin A1 c and obesity co-related diseases were recorded and compared preoperatively and 2 years after operation. Results LSG were successfully completed in all patients, the mean operation time was(70.7±26.3) min, postoperative hospitalization time was(7.0±1.7) d. All patients were followed up for more than 2 years without perioperative mortality and postoperative severe complications. Three months after operation, body mass and BMI decreased significantly(P<0.05). In the 24 patients with hypertension, the average arterial pressure decreased significantly 1 months after operation and remained relatively stable thereafter(P<0.05). Among them, 15 patients returned to normal blood pressure in 2 years after operation, without oral antihypertensive drugs, the complete remission rate was 63%. In the 35 patients with hypertriglyceridemia, serum triglyceride decreased significantly 6 months after operation(P<0.05), while high density lipoprotein increased statistically 1 year after operation(P<0.05). In the 32 patients with type 2 diabetes, fasting plasma glucose decreased significantly 1 months after operation(P<0.05), and the same to glycosylated hemoglobin A1 c(P<0.05). Among them, 12 patients were completely cured without drug treatment and the cure rate was 37.5%. Obesity-related diseases such as fatty liver, sleep apnea and joints degeneration, also improved in 2 years after operation. Conclusions LSG is effective and safe in the treatment of obesity. It can significantly reduce body weight, and cure or significantly improve related metabolic syndrome at the same time.
Objective To estimate the effect and safety of laparoscopic sleeve gastrectomy for metabolic syndrome. Methods Clinical data of 50 patients accepting laparoscopic sleeve gastrectomy were analyzed retrospectively. Body mass, body mass index(BMI), mean arterial pressure, serum triglyceride, high density lipoproteins, fasting plasma glucose,glycosylated hemoglobin A1 c and obesity co-related diseases were recorded and compared preoperatively and 2 years after operation. Results LSG were successfully completed in all patients, the mean operation time was(70.7±26.3) min, postoperative hospitalization time was(7.0±1.7) d. All patients were followed up for more than 2 years without perioperative mortality and postoperative severe complications. Three months after operation, body mass and BMI decreased significantly(P<0.05). In the 24 patients with hypertension, the average arterial pressure decreased significantly 1 months after operation and remained relatively stable thereafter(P<0.05). Among them, 15 patients returned to normal blood pressure in 2 years after operation, without oral antihypertensive drugs, the complete remission rate was 63%. In the 35 patients with hypertriglyceridemia, serum triglyceride decreased significantly 6 months after operation(P<0.05), while high density lipoprotein increased statistically 1 year after operation(P<0.05). In the 32 patients with type 2 diabetes, fasting plasma glucose decreased significantly 1 months after operation(P<0.05), and the same to glycosylated hemoglobin A1 c(P<0.05). Among them, 12 patients were completely cured without drug treatment and the cure rate was 37.5%. Obesity-related diseases such as fatty liver, sleep apnea and joints degeneration, also improved in 2 years after operation. Conclusions LSG is effective and safe in the treatment of obesity. It can significantly reduce body weight, and cure or significantly improve related metabolic syndrome at the same time.
引文
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[12]汤聪,梁文丰,岑宏,等.袖状胃切除及胃旁路手术对合并肥胖2型糖尿病近、远期疗效的Meta分析[J].中华普通外科学文献(电子版),2014,8(4):321-331.
[13]李世星,姜涛,于洋.腹腔镜袖状胃切除术治疗肥胖型2型糖尿病的疗效分析[J].中华肥胖与代谢病电子杂志,2017,3(4):215-219.
[14]Kowalewski PK,Olszewski R,Waledziak MS,et al.Long-Term Outcomes of Laparoscopic Sleeve Gastrectomy-a Single-Center,Retrospective Study[J].Obesity Surgery,2018,28(1):130-134.
[15]Sarkhosh K,Birch DW,Shi X,et al.The impact of sleeve gastrectomy on hypertension:a systematic review[J].Obesity Surgery,2012,22(5):832-837.
[16]章雄,余波,王廷峰,等.减重手术治疗肥胖合并Ⅱ型糖尿病的机制探讨[J].中国微创外科杂志,2014,14(11):1045-1048.
[17]Karamanakos SN,Vagenas K,Kalfarentzos F,et al.Weight loss,appetite suppression,and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy:a prospective,double blind study[J].AnnSurg,2008,247(3):401-407.
[18]Dunn JP,Cowan RL,Volkow ND,et al.Decreased dopamine type 2receptor availability after bariatric surgery:preliminary findings[J].Brain Res,2010,13(5):123-130.
[2]Vest AR,Heneghan HM,Agarwal S,et al.Bariatric surgery and cardiovascular outcomes:a systematic review[J].Heart,2012;98(24):1763-1777.
[3]汤朝辉,Mustafa H,Vivek NP,等.腹腔镜袖状胃切除治疗病态性肥胖及2型糖尿病的意义及国际专家共识[J].中国实用外科杂志,2007,33(1):13-16.
[4]中国医师协会外科医师分会肥胖和糖尿病外科医师委员会.中国肥胖和2型糖尿病外科治疗指南(2014)[J].中国实用外科杂志,2014,34(11):1005-1010.
[5]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[6]时延伟,王广发,张成,等.Epworth嗜睡量表在阻塞性睡眠呼吸暂停低通气综合征筛查中的应用价值[J].中国呼吸与危重监护杂志,2009,8(5):456-460.
[7]Fontaine KR,Redden DT,Wang Chenxi,et a1.Years of life lost due to obesity[J].JAMA,2003,289(2):187-193.
[8]Schauer PR,Bhatt DL,Kirwan JP,et al.Bariatric Surgery versus Intensive Medical Therapy for Diabetes-5-Year Outcomes[J].N Engl J Med,2017,376(7):641-651.
[9]Pareek M,Schauer PR,Kaplan LM,et al.Metabolic Surgery:Weight Loss,Diabetes,and Beyond[J].Journal of the American College of Cardiology,2018,71(6):670-687.
[10]Schauer PR,Kashyap SR,Wolski K,et a1.Bariatric surgery versus intensive medical therapy in obese patients with diabetes[J].N Engl J Med,2012,366(17):1567-1576.
[11]雒洪志,陈宏,梁义,等.腹腔镜袖状胃切除术治疗重度肥胖症的临床疗效[J].中国微创外科杂志,2012,12(12):1067-1071.
[12]汤聪,梁文丰,岑宏,等.袖状胃切除及胃旁路手术对合并肥胖2型糖尿病近、远期疗效的Meta分析[J].中华普通外科学文献(电子版),2014,8(4):321-331.
[13]李世星,姜涛,于洋.腹腔镜袖状胃切除术治疗肥胖型2型糖尿病的疗效分析[J].中华肥胖与代谢病电子杂志,2017,3(4):215-219.
[14]Kowalewski PK,Olszewski R,Waledziak MS,et al.Long-Term Outcomes of Laparoscopic Sleeve Gastrectomy-a Single-Center,Retrospective Study[J].Obesity Surgery,2018,28(1):130-134.
[15]Sarkhosh K,Birch DW,Shi X,et al.The impact of sleeve gastrectomy on hypertension:a systematic review[J].Obesity Surgery,2012,22(5):832-837.
[16]章雄,余波,王廷峰,等.减重手术治疗肥胖合并Ⅱ型糖尿病的机制探讨[J].中国微创外科杂志,2014,14(11):1045-1048.
[17]Karamanakos SN,Vagenas K,Kalfarentzos F,et al.Weight loss,appetite suppression,and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy:a prospective,double blind study[J].AnnSurg,2008,247(3):401-407.
[18]Dunn JP,Cowan RL,Volkow ND,et al.Decreased dopamine type 2receptor availability after bariatric surgery:preliminary findings[J].Brain Res,2010,13(5):123-130.