腹腔镜下可调节胃束带术及多学科综合治疗重度肥胖症及其合并症

Application of Laparoscopic Adjustable Gastric Banding and A Multi-disciplinary Team Approach in Treatment of Morbid Obesity and Its Complications

目的评估腹腔镜下可调节胃束带术(LAGB)及多学科(MDT)综合治疗重度肥胖症及其合并症的效果。方法回顾性分析2009年10月至2011年2月在北京协和医院接受LAGB及MDT综合治疗的16例重度肥胖症患者的临床资料,总结减重及合并症改善情况。结果 16例患者中,15例完成术后3个月回访,平均体重(P=0.000)和BMI(P=0.000)均明显低于术前,额外体重减轻百分比(%EWL)为(25.7±7.4)%。13例完成术后6个月回访,术后6个月平均体重(P=0.001)和BMI(P=0.001)明显低于术前,与术后3个月差异无统计学意义(P=0.103,P=0.053);术后6个月的%EWL为(37.0±14.7)%,明显高于术后3个月的(29.1±6.8)%(P=0.042)。6例完成术后12个月回访,术后3个月平均体重明显低于术前(P=0.007),术后6个月与术后3个月差异无统计学意义(P=0.065),术后12个月明显低于术后6个月(P=0.007);术后3个月的平均BMI明显低于术前(P=0.005),术后6个月明显低于术后3个月(P=0.045),术后12个月明显低于术后6个月(P=0.013);术后3、6、12个月的%EWL分别为(29.6±6.8)%、(42.4±14.0)%、(60.4±12.6)%,术后6个月明显低于术后3个月(P=0.028),术后12个月明显低于术后6个月(P=0.001)。9例术前合并阻塞性睡眠呼吸暂停低通气综合征的患者,术后自觉症状均明显缓解。16例术前合并代谢综合征的患者中,10例术后病情得到明显改善。9例术前合并高血压的患者中,7例术后停用降压药物,血压恢复正常;1例减少药量,1例改用更缓和的降压药物。8例术前合并2型糖尿病的患者中,7例术后停用降糖药物,血糖恢复正常;1例降糖药物剂量减少。结论 LAGB及MDT综合治疗病态肥胖及其合并症安全有效、切实可行。

Objective To assess the safety and feasibility of laparoscopic adjustable gastric banding （LAGB） and a multi-disciplinary team（MDT） approach in the treatment of morbid obesity and its complications.Methods We retrospectively analyzed the clinical data of 16 patients who underwent LAGB and MDT approach in Peking Union Medical College Hespital from October 2009 to February 2011.Results Of these 16 patients,15 patients completed the 3-month follow-up;their body weight and body mass index（BMI） decreased significantly after treatment（both P=0.000）,with an percentage of excess weight loss（%EWL） of（25.7±7.4）%.Thirteen patients completed 6-month follow-up;their body weight and BMI were significantly lower than the preoperative levels（both P=0.001）,while there were no significant difference between the third-and sixth-month measurements（P=0.103 and P=0.053,respectively）;%EWL of 6 months after operation was significantly higher than that of 3 months after operation [（37.0±14.7）% vs.（29.1±6.8）%,P=0.042].Six patients completed 12-month follow-up;their body weight and BMI decreased significantly at the first 3 months after operation（P=0.007 and P=0.005,respectively） and at the second 6 postoperative months（P=0.007 and P=0.013,respectively）;the BMI of 6 months after operation was significantly lower than that of 3 months after operation（P=0.045）,but there was no significant difference of body weight between the third and sixth month after operation（P=0.065）;meanwhile,the %EWL increased significantly within the second 3 postoperative months from（29.6±6.8）% to（42.4±14.0）%（P=0.028）,and also within the second 6 postoperative months（60.4±12.6）%（P=0.001）.In 9 patients with pre-operative obstructive sleep apnea-hypopnea syndrome,the symptom was remarkably resolved in all these 9 patients 3 months after the treatment.Of 16 patients with preoperative metabolic syndrome,the condition was obviously improved after treatment in 10 patients.Of 9 patients with hypertension preoperatively,the blood pressure returned to normal level after the withdrawal of antihypertensive agents in 7 patients;in addition,one patient had his dose dcreased and one patient switched to a milder antihypertensive agent.Of 8 patients accompanied with type 2 diabetes,7 had their antidiabetic drugs withdrawn after the blood sugar returned normal and one patient had his dose decreased.Conclusion LAGB combined with MDT approach is effective,safe,and feasible for treating morbid obesity and its complications.