腹腔镜Roux-en-Y胃旁路术与腹腔镜胃袖状切除术治疗肥胖合并2型糖尿病术后恶心呕吐发生率的对比研究(附376例报告)

Comparative study of the incidence of postoperative nausea and vomiting between laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the treatment of obese patients with type 2 diabetes mellitus: with a report of 376 cases

目的：比较腹腔镜Roux-en-Y胃旁路术（1aparoscopic Roux-en-Y gastric bypass，LRYGB）与腹腔镜胃袖状切除术（laparoscopic sleve gastrectomy，LSG）治疗肥胖合并．2型糖尿病（type 2 diabetes mellitus，T2DM）患者术后恶心呕吐（postopera-tive nausea and vomiting，PONV）的发生率及其严重程度。方法：采用前瞻性单盲非随机对照的方法纳入2011年1月至2013年4月85例18～65岁的患者，其中男28例，女57例。按照患者的知情同意及意愿分为LRYGB组与LSG组。采用七氟醚、氧气空气混合物的标准麻醉方法。评估术后0～24h患者PONV（恶心、干呕／呕吐）的表现与严重性、疼痛评分、止吐药使用情况及患者满意度。结果：术后0～6h，两组患者PONV及疼痛评分差异无统计学意义（P〉0．05）；术后6～24h，LRYGB组患者PONV发生率（18．3％VS．44．0％）、严重呕吐发生率（10．0％VS．28．0％）及平均疼痛评分[（2．7±1．6）VS．（3．6±1．9）]明显低于LSG组。总体而言，LRYGB组患者PONV发生率（43．3％VS．72．0％）、严重呕吐发生率（20．0％vs．44．0％）明显低于LSG组。LRYGB组患者6h（55．0％VS．28．0％）及24h（83．3％vs．60．0％）麻醉后满意度明显高于LSG组。结论：与LSG相比．LRYGB降低了术后24h内PONV的发生率及其严重程度。但尚需更多随机预期实验制定更加标准的方法以减少PONV的发生；同时，需要更多的随机前瞻性对照研究，以评估LRYGB与LSG治疗肥胖合并T2DM患者术后PONV的差异。

Objective：To compare the incidence and severity of postoperative nausea and vomiting （PONV） between laparo- scopic Roux-en-Y gastric bypass （LRYGB） and laparoscopie sleeve gastrectomy （LSG） in the treatment of obese patients with type 2 diabetes mellitus （T2DM）. Methods： This prospective, non-randomized, single-blind study enrolled 85 patients （57 females and 28 males ） with age ranging from 18 to 65 who were scheduled for LRYGB or LSG in accordance with the patientg informed consent and wi- shes from Jan. 2011 to Apr. 2013. A standard anesthetic technique, including sevoflurane and air in oxygen ,was used. During a 0-24 h postoperative period, the presence and severity of PONV （nausea, retching/vomiting） , pain score, need for antiemetics and the degree of patients satisfaction were evaluated. Results：During the 0-6 h postoperative period, the incidence of PONV and mean pain score in both group were not significantly different [40.0% vs. 52.0%, （4.1 ±1.9） vs. （4.6±2.0） in group LRYGB and LSG respectively]. At 6-24 h postoperatively,the incidence of PONV （18.3% vs. 44.0% ） ,severe emesis （10.0% vs. 28.0% ） and mean pain score [ （2.7 ± 1.6） vs. （ 3.6 ±1.9 ） ] were significantly lower in group LRYGB compared with group LSG. Overall, the incidence of PONV （43.3% vs. 72.0 % ） and severe emesis （20.0% vs. 44.0% ） were significantly lower in group LRYGB compared with group LSG. The percentage of satisfied patients 6 and 24 h after the end of anesthesia （55.0% vs. 28.0% and 83.3% vs. 60.0% ） were signifi- cantly higher in group LRYGB compared with group LSG. Conclusions：LRYGB reduces the incidence and severity of PONV comparedwith LSG during a 0-24 h postoperative period. However, more randomized prospective tests are needed for creation of more standard method for decrease of PONV, and more randomized prospective control experiments are needed for further evaluation of difference in postoperative PONV between LRYGB and LSG in the treatment of obese patients with T2DM.