腹腔镜手术治疗219例肥胖症疗效分析

Outcomes after laparoscopic surgery for 219 patients with obesity

目的探讨腹腔镜下胃肠外科手术治疗单纯性肥胖症及其合并2型糖尿病（T2DM）患者的效果及安全性。方法上海第二军医大学附属长海医院微创外科2003年6月至2010年6月间对219例肥胖症患者进行了腹腔镜下胃肠外科手术，其中201例行腹腔镜下可调节胃绑带术（LAGB组），13例行腹腔镜下改良简易型胃肠短路术（LMGB组），5例行腹腔镜下管状胃胃切除术（LSG组）。总结分析该组患者的临床和随访资料。结果LAGB组患者体质量指数（BMI）平均37．9kg／m2，术后6个月及12个月BMI分别为平均32．4kg／mz和29．7kg／m2；43例术前合并T2DM者．11例（25．6％）术后临床部分缓解，16例（37．2％）完全缓解；有26例（12．9％）术后出现并发症。LMGB组患者BMI平均34．7kg／m2，术后6个月及12个月BMl分别为平均31．6kg／m2和26．9kg／m2：10例术前合并T2DM者，2例（20．0％）术后临床部分缓解，7例（70．0％）完全缓解；有2例（15．4％）术后出现并发症。LSG组患者BMI平均43．8kg／m2．术后6个月及12个月BMl分别为平均38．1kg／m2和34．3kg／m2；3例术前合并T2DM者，术后1例达到临床部分缓解，1例完全缓解：有1例术后出现并发症。所有术式组均无围手术期死亡。结论腹腔镜下胃肠外科手术对单纯性肥胖症有效．并能使合并的T2DM得到缓解．同时手术并发症较少。

Objective To evaluate the outcomes after laparoscopic gastrointestinal surgery for patients with obesity and type 2 diabetes mellitus （T2DM）. Methods From June 2003 to June 2010, 219 patients underwent laparoscopie gastrointestinal surgery for obesity and T2DM, including laparoseopie adjustable gastric banding （LAGB,n=201）, laparoscopic mini gastric bypass （LMGB,n=13）, and laparoscopic sleeve gastrectomy （LSG, n=5）. Clinical data were analyzed retrospectively. Results The mean body mass index （BMI） of patients who received LAGB was 37.9 kg/m2, and decreased to 32.4 kg/m2 at 6 months and to 29.7 kg/m2 at 12 months. In 43 patients who had concurrent T2DM, 11 （25.6%） showed clinical partial remission （CPR） and 16 （ 37.2% ） clinical complete remission （CCR）. Postoperative complications occurred in 26 patients （12.9%）. The mean BMI of patients undergoing LMGB was 34.7 kg/m2, and decreased to 31.6 kg/m2 at 6 months and 26.9 kg/m2 at 12 months after surgery. Ten patients had T2DM before operation, of whom 2（20.0%）had CPR and 7（70.0%） CCR postoperatively. Postoperative complications occurred in 2 patients （15.4%）. The mean BMI of patients who underwent LSG was 43.8 kg/m2, and was reduced to 38.1 kg/m2 at 6 months and 34.3 kg/m2 at 12 months after operation. Three patients were diagnosed with T2DM before operation. One patient （33.3%） had CPR and 1（33.3%） reached CCR after operation. There was 1（20.0%） patient who developed complication. No perioperative death occurred. Conclusion Laparoseopic gastrointestinal surgery may result in satisfactory weight loss and clinical remission of T2DM with few complications.