精准腹腔镜胃袖状切除术治疗肥胖症的疗效

Efficacy of precision laparoscopic sleeve gastrectomy for the treatment of obesity

目的探讨精准腹腔镜胃袖状切除术（LSG）治疗肥胖症的疗效。方法回顾性分析2011年8月至2013年7月暨南大学附属第一医院收治的50例施行精准LSG治疗肥胖症患者的临床资料。记录术前、术后患者BMI、并发症情况以及相关代谢性疾病缓解情况。结果50例患者均顺利完成LSG，手术时间为（59±10）min，出血量为（10±4）ml，术后住院时间为（5．2±1．1）d。术后患者未发生严重并发症。术后随访时间〉1年的23例患者多余体质量减少率（EWL）为80％±18％，BMI下降（10．1±3．4）kg／m2；术后随访6～12个月的13例患者EWL为71％±15％，BMI下降（8．6±2．3）kg／m2；随访1～6个月（不含6个月）的14例患者EWL为28％±12％，BMI下降（4．2±1．6）kg／m。。6例合并胰岛素抵抗患者恢复正常；6例合并脂肪肝患者，5例血脂水平下降，1例变化不明显；4例合并2型糖尿病患者中，3例无需药物控制血糖，1例口服降糖药物控制良好；3例合并高血压患者停用降压药物血压控制良好。结论施行精准LSG治疗肥胖症，术中采取精细、准确的操作，减少术中、术后并发症，可取得满意疗效，使患者获益。

Objective To investigate the efficacy of precision laparoscopic sleeve gastrectomy （LSG） for the treatment of obesity. Methods The clinical data of 50 obese patients who received LSG under the guidance of ＂precise weight loss surgery＂ at the First Affiliated Hospital of Jinan University from August 2011 to July 2013 were retrospectively analyzed. The body mass index （BMI） , complication and metabolic disease remission before and after operation were recorded. Results All the 50 patients successfully underwent LSG. The operation time, blood loss, postoperative duration of hospital stay were （59 -＋ 10） minutes, （ 10 -＋ 4） ml and （5.2 -＋ 1.1 ） days. No severe complications were observed. The percentage of excess weight loss （EWL） and decrease of BMI of 23 patients who were followed up for more than 1 year were 80% -＋ 18% and （ 10.1 -＋ 3.4） kg/m2 , respectively; the percentage of EWL and decrease of BMI of 13 patients who were followed up for 6-12 months were 71% _＋ 15% and （ 8.6 _＋ 2.3 ） kg/m2, respectively ; the percentage of EWL and decrease of BMI of 14 patients who were followed up for 1-6 months were 28% _＋ 12% and （4.2 _＋ 1.6） kg/m2 , respectively. The condition of 6 patients with insulin resistance was back to normal. Six patients had hepatic adipose infiltration, 5 of them had lipid levels decreased, and the change of lipid level was not obvious in the other 1 patient. Four patients bad type 2 diabetes mellitus, 3 patients did not need therapy, 1 patient only needed drug therapy. Three patients had hypertension, and their blood pressure was controlled at the normal level after stop of drug administration. Conclusion The incidence of postoperative complication could be reduced by fine and accurate manipulation and applying the ＂precision weight loss surgery＂ in operation.