腹腔镜袖状胃切除术治疗肥胖及其合并症的疗效分析
|
摘要
目的探讨腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)对肥胖及肥胖合并疾病的疗效及安全性。方法回顾性分析首都医科大学附属北京天坛医院于2012年7月至2017年11月接受LSG的90例单纯性肥胖病人临床资料。观察术后体质量指数、多余体重减少百分比(percentage of excess weight loss,%EWL)以及肥胖合并疾病的改善情况及手术相关并发症情况。结果所有病人均顺利完成LSG,无中转开腹。手术时间为(67.2±4.9) min(50～170 min),术中出血量为(21.2±1.5) ml(10～50 ml),术后住院时间为(5.1±0.3) d(5～13 d),术后腹腔积液、腹腔出血各1例,无二次手术病例。术后3、6、9、12、18、24个月时%EWL分别为63.8%、74.8%、77.4%、79.0%、79.2%、79.8%,随访3～60个月未出现不可控制的体重下降等恶性营养不良。随访期间出现胆囊结石、缺铁性贫血、胃食管反流症状。术后肥胖相关疾病糖尿病、高血压、脂肪肝、高脂血症等均有明显改善。结论 LSG治疗单纯性肥胖症减重效果确切、安全,对肥胖相关疾病有明显的改善。
Objective To investigate the efficacy and safety of laparoscopic sleeve gastrectomy(LSG) for obesity and its related diseases. Methods Clinical data of 90 patients with simple obesity who underwent laparoscopic sleeve gastrectomy from July 2012 to November 2017 in Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively. Body mass index(BMI), excess weight loss(EWL), obesity and complications were observed.Results All cases were successfully completed in laparoscopic sleeve gastrectomy without conversion to laparotomy. The surgical duration was 67.2(50-170) min, with a blood loss of 21.2±1.5(10-50)ml, and mean postoperative hospital stay was 5.1±0.3(5-13) days. 1 case had postoperative abdominal effusion and 1 case had intra-abdominal hemorrhage, all of which didn't undergo secondary operation. The %EWL was 63.8%, 74.8%, 77.4%, 79.0%, 79.2%, and 79.8% at 3, 6, 9, 12, 18, and 24 months after surgery, respectively, and no uncontrollable weight loss or other malignant malnutrition occurred during 3 to 60 months of follow-up. Gallstones, iron deficiency anemia, and gastroesophageal reflux symptoms developed during the follow-up period. Postoperative obesity-related diseases such as diabetes, hypertension, fatty liver, and hyperlipidemia were significantly improved.Conclusions Laparoscopic sleeve gastrectomy is effective and safe in the treatment of simple obesity, with significant improvement in obesity-related diseases.
Objective To investigate the efficacy and safety of laparoscopic sleeve gastrectomy(LSG) for obesity and its related diseases. Methods Clinical data of 90 patients with simple obesity who underwent laparoscopic sleeve gastrectomy from July 2012 to November 2017 in Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively. Body mass index(BMI), excess weight loss(EWL), obesity and complications were observed.Results All cases were successfully completed in laparoscopic sleeve gastrectomy without conversion to laparotomy. The surgical duration was 67.2(50-170) min, with a blood loss of 21.2±1.5(10-50)ml, and mean postoperative hospital stay was 5.1±0.3(5-13) days. 1 case had postoperative abdominal effusion and 1 case had intra-abdominal hemorrhage, all of which didn't undergo secondary operation. The %EWL was 63.8%, 74.8%, 77.4%, 79.0%, 79.2%, and 79.8% at 3, 6, 9, 12, 18, and 24 months after surgery, respectively, and no uncontrollable weight loss or other malignant malnutrition occurred during 3 to 60 months of follow-up. Gallstones, iron deficiency anemia, and gastroesophageal reflux symptoms developed during the follow-up period. Postoperative obesity-related diseases such as diabetes, hypertension, fatty liver, and hyperlipidemia were significantly improved.Conclusions Laparoscopic sleeve gastrectomy is effective and safe in the treatment of simple obesity, with significant improvement in obesity-related diseases.
引文
[1] Demaria EJ,Sugerman HJ,Kellum JM,et al.Results of 281 Consecutive Total Laparoscopic Roux-en-Y Gastric Bypasses to Treat Morbid Obesity[J].Ann Surg,2002,235(5):640-647.DOI:10.1097/00000658-200205000-00005.
[2] Rosenthal RJ.International Sleeve Gastrectomy Expert Panel Consensus Statement:best practice guidelines based on experience of >12,000 cases[J].Surg Obes Relat Dis,2012,8(1):8-19.DOI:10.1016/j.soard.2011.10.019.
[3] Kizy S,Jahansouz C,Downey MC,et al.National Trends in Bariatric Surgery 2012-2015:Demographics,Procedure Selection,Readmissions,and Cost[J].Obes Surg,2017,27(11):1-7.DOI:10.1007/s11695-017-2719-1.
[4] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2010年版)[J].中国糖尿病杂志,2012,20(1):54-109.DOI:10.3969/j.issn.1672-7185.2012.06.001.
[5] Almogy G,Crookes PF,Anthone GJ.Longitudinal gastrectomy as a treatment for the high-risk super-obese patient[J].Obes Surg,2004,14(4):492-497.DOI:10.1381/096089204323013479.
[6] Liu YW,Wong KH,Lam CH,et al.Long-term results on weight loss and diabetes remission after laparoscopic sleeve gastrectomy for a morbidly obese chinese population[J].Obes Surg,2015,25(10):1901-1908.DOI:10.1007/s11695-015-1628-4.
[7] Boza C,Daroch D,Barros D,et al.Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure[J].Surg Obes Relat Dis,2014,10(6):1129-1133.DOI:10.1016/j.soard.2014.03.024.
[8] Lee CM,Cirangle PT,Jossart GH.Vertical gastrectomy for morbid obesity in 216 patients:report of two-year results[J].Surg Endosc,2007,21(10):1810-1816.DOI:10.1007/s00464-007-9276-y.
[9] Deitel M,Gagner M,Erickson AL,et al.Third International Summit:Current status of sleeve gastrectomy[J].Surg Obes Relat Dis,2011,7:749-759.DOI:10.1016/j.soard.2011.07.017.
[10] Gehrer S,Kern B,Peters T,et al.Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy(LSG)than after laparoscopic Roux-Y-gastric bypass(LRYGB)-a prospective study[J].Obes Surg,2010,20:447-453.DOI:10.1007/s11695-009-0068-4.
[11] Gentileschi,Paolo.Laparoscopic sleeve gastrectomy as a primary operation for morbid obesity:experience with 200 patients[J].Gastroent Res Pract,2012,2012:801325.DOI:10.1155/2012/801325.
[12] 沈迪建,叶环,王跃东,等.腹腔镜袖状胃切除术对肥胖相关疾病的治疗分析[J].中华胃肠外科杂志,2012,15(11):1139-1141.DOI:10.3760/cma.j.issn.1671-0274.2012.11.013.
[13] 钱东,张辰,赵宏志,等.腹腔镜袖状胃切除术后远期效果分析[J].腹腔镜外科杂志,2011,16(11):814-815.
[14] Nath A,Leblanc KA,Hausmann MG,et al.Laparoscopic sleeve gastrectomy:our first 100 patients[J].JSLS,2010,14(4):502-508.DOI:10.4293/108680810X12924466007809.
[15] Pradarelli JC,Varban OA,Ghaferi AA,et al.Hospital variation in perioperative complications for laparoscopic sleeve gastrectomy in Michigan[J].Surgery,2016,159(4):1113-1120.DOI:10.1016/j.surg.2015.08.044.
[16] Nath A,Koch T,Yewale S,et al.Dysphagia after vertical sleeve gastrectomy:Evaluation of risk factors and assessment of endoscopic intervention[J].World J Gastroenterol,2016(47):119-127.DOI:10.3748/wjg.v22.i47.10371.
[17] Abou RA,Basile M,El MH.Gastric leaks post sleeve gastrectomy:review of its prevention and management.[J].World J Gastroenterol,2014,20(38):13904-13910.DOI:10.3748/wjg.v20.i38.13904.
[18] Durmush EK,Ermerak G,Durmush D.Short-term outcomes of sleeve gastrectomy for morbid obesity:does staple line reinforcement matter?[J].Obes Surg,2014,24(7):1109-1116.DOI:10.1007/s11695-014-1251-9.
[19] Himpens J,Dapri G.A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy:results after 1 and 3 years[J].Obes Surg,2006,16(11):1450-1456 DOI:10.1381/096089206778869933.
[2] Rosenthal RJ.International Sleeve Gastrectomy Expert Panel Consensus Statement:best practice guidelines based on experience of >12,000 cases[J].Surg Obes Relat Dis,2012,8(1):8-19.DOI:10.1016/j.soard.2011.10.019.
[3] Kizy S,Jahansouz C,Downey MC,et al.National Trends in Bariatric Surgery 2012-2015:Demographics,Procedure Selection,Readmissions,and Cost[J].Obes Surg,2017,27(11):1-7.DOI:10.1007/s11695-017-2719-1.
[4] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2010年版)[J].中国糖尿病杂志,2012,20(1):54-109.DOI:10.3969/j.issn.1672-7185.2012.06.001.
[5] Almogy G,Crookes PF,Anthone GJ.Longitudinal gastrectomy as a treatment for the high-risk super-obese patient[J].Obes Surg,2004,14(4):492-497.DOI:10.1381/096089204323013479.
[6] Liu YW,Wong KH,Lam CH,et al.Long-term results on weight loss and diabetes remission after laparoscopic sleeve gastrectomy for a morbidly obese chinese population[J].Obes Surg,2015,25(10):1901-1908.DOI:10.1007/s11695-015-1628-4.
[7] Boza C,Daroch D,Barros D,et al.Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure[J].Surg Obes Relat Dis,2014,10(6):1129-1133.DOI:10.1016/j.soard.2014.03.024.
[8] Lee CM,Cirangle PT,Jossart GH.Vertical gastrectomy for morbid obesity in 216 patients:report of two-year results[J].Surg Endosc,2007,21(10):1810-1816.DOI:10.1007/s00464-007-9276-y.
[9] Deitel M,Gagner M,Erickson AL,et al.Third International Summit:Current status of sleeve gastrectomy[J].Surg Obes Relat Dis,2011,7:749-759.DOI:10.1016/j.soard.2011.07.017.
[10] Gehrer S,Kern B,Peters T,et al.Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy(LSG)than after laparoscopic Roux-Y-gastric bypass(LRYGB)-a prospective study[J].Obes Surg,2010,20:447-453.DOI:10.1007/s11695-009-0068-4.
[11] Gentileschi,Paolo.Laparoscopic sleeve gastrectomy as a primary operation for morbid obesity:experience with 200 patients[J].Gastroent Res Pract,2012,2012:801325.DOI:10.1155/2012/801325.
[12] 沈迪建,叶环,王跃东,等.腹腔镜袖状胃切除术对肥胖相关疾病的治疗分析[J].中华胃肠外科杂志,2012,15(11):1139-1141.DOI:10.3760/cma.j.issn.1671-0274.2012.11.013.
[13] 钱东,张辰,赵宏志,等.腹腔镜袖状胃切除术后远期效果分析[J].腹腔镜外科杂志,2011,16(11):814-815.
[14] Nath A,Leblanc KA,Hausmann MG,et al.Laparoscopic sleeve gastrectomy:our first 100 patients[J].JSLS,2010,14(4):502-508.DOI:10.4293/108680810X12924466007809.
[15] Pradarelli JC,Varban OA,Ghaferi AA,et al.Hospital variation in perioperative complications for laparoscopic sleeve gastrectomy in Michigan[J].Surgery,2016,159(4):1113-1120.DOI:10.1016/j.surg.2015.08.044.
[16] Nath A,Koch T,Yewale S,et al.Dysphagia after vertical sleeve gastrectomy:Evaluation of risk factors and assessment of endoscopic intervention[J].World J Gastroenterol,2016(47):119-127.DOI:10.3748/wjg.v22.i47.10371.
[17] Abou RA,Basile M,El MH.Gastric leaks post sleeve gastrectomy:review of its prevention and management.[J].World J Gastroenterol,2014,20(38):13904-13910.DOI:10.3748/wjg.v20.i38.13904.
[18] Durmush EK,Ermerak G,Durmush D.Short-term outcomes of sleeve gastrectomy for morbid obesity:does staple line reinforcement matter?[J].Obes Surg,2014,24(7):1109-1116.DOI:10.1007/s11695-014-1251-9.
[19] Himpens J,Dapri G.A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy:results after 1 and 3 years[J].Obes Surg,2006,16(11):1450-1456 DOI:10.1381/096089206778869933.