腹腔镜胃袖状切除术治疗病态性肥胖症的5年疗效分析

Efficacy of laparoscopic sleeve gastrectomy for the treatment of morbid obesity： a 5-year study

目的评价腹腔镜胃袖状切除术（LSG）治疗病态性肥胖症的5年疗效。方法回顾性分析2006年1月至2007年12月中国医科大学附属盛京医院收治的31例病态性肥胖症患者的临床资料。31例患者行LSG，观察患者围手术期及远期并发症情况、手术前后降糖药物或胰岛素应用情况，检测患者术后6个月、1、2、3、4、5年BMI和多余体质量减少率（EWL），分析患者术后合并症缓解率、并发症发生率及患者满意度评分。率的比较采用Ⅳ。检验或Fisher确切概率法。对于各组重复测量数据应用重复测量方差分析，对于满足球形检验数据无需校正，如需校正采用Greenhouse—Geisser校正。结果患者术后连续随访5年，其中25例患者完成随访。随访患者中，胃食管反流病发生率为16．0％（4／25），经药物治疗后缓解；吻合口狭窄发生率为4．0％（1／25）；8．0％（2／25）的患者EWL〈60％；16．0％（4／25）的患者偶尔有腹痛发生。糖尿病患者比例由术前的9．7％（3／31）下降至术后5年的4．0％（1／25），术前与术后5年比较，差异有统计学意义（P〈0．05）。脂肪肝患者比例由术前的93．5％（29／31）下降至术后5年的32．0％（8／25），术前与术后5年比较，差异有统计学意义（X2=19．10，P〈0．05）。高脂血症患者比例由术前的77．4％（24／31）下降至术后5年的12．0％（3／25），术前与术后5年比较，差异有统计学意义（，=35．5l，P〈0．05）。BMI由术前的（38．8±4．2）kg／i31。下降至术后5年的（28．5±3．1）kg／m2，术前与术后各时间段比较，差异有统计学意义（F=113．36，P〈0．05）。EWL由术后6个月的42％±11％增加至术后5年的69％±16％，术后各时间段比较，差异有统计学意义（F=41．71，P〈0．05）。患者术后5年各时间段疗效满意度评分比较，差异无统计学意义（F=0．92，P〉0．05）。结论LSG减重效果显著，远期并发症少。

Objective To investigate the 5-year efficacy of laparoscopic sleeve gastrectomy for the treat- ment of morbid obesity. Methods The clinical data of 31 patients with severe morbid obesity and related compli- cations who were admitted to the Shengjing Hospital of Chinese Medical University front January 2006 to December 2007 were retrospectively analyzed. The 31 patients received laparoscopic sleeve gastrectomy and were followed up for 5 years to observe the perioperative condition, incidence of long-term complications, application of hypoglycemie drug and insulin before and after operation, the body mass index （BMI） was detected 6 months, 1, 2, 3, 4, 5 years after operation, and the decrease of excess weight loss （EWL） was analyzed. The remission rate of compli- cations, incidence of complications and the patient satisfaction score were recorded. The count data were analyzed using the chi-square test or Fisher exact probability. Repeated measurement data were analyzed using the repeated measure ANOVA, a Greenhouse-Geisser adjustment was used to correct serial dependency. Results Twenty-five patients were followed up for 5 years postoperatively. Of the 25 patients, 4 （ 16.0% ） had gastroesophageal reflux disease, and were cured by medical treatment; 1 patient （4%） had anastomotic stenosis; the percentage of EWL of 2 patients （8.0%） was under 60% ; 4 patients （16.0%） had occasional obdominal pain. The percentage of patients with diabetes mellitus was decreased from preoperative 9.7% （3/31） to postoperative 4.0% （1/25）, with a significant difference （P 〈 O. 05 ）. The percentage of patients with fatty liver was decreased from preoperative 93.5% （29/31 ） to postoperative 32.0% （8/25）, with significant difference （X2 = 19. 10, P 〈 0.05 ）. The percentage of patients with hyper｜ipidemia was decreased from preoperative 77.4% （ 24/31 ） to postoperative 12.0% （ 3/25 ）, with significant difference （X2 = 35.51, P 〈 0.05 ）. The level of BMI was decreased from preoperative （38.8 ＋ 4.2） kgc/m2 to postoperative （28.5 -＋ 3.1 ） kg/m2, with significant difference （ F = 113.36, P 〈 0.05 ）. The percentage of EWL was increased from preoperative 42%-＋ 11% to postoperative 69% _＋ 16%, with significant difference （F = 41.71, P 〈0.05 ）. There was no significant difference in the patient satisfaction score between each year within the 5 years （ F = 0. 92, P 〉 0.05 ）. Conclusions Laparoscopic sleeve gastrectomy is effective in losing weight with few long-term complications.