腔镜下胃旁路术治疗肥胖症及其合并症

Safety and efficacies of laparoscopic Roux-en-Y gastric bypass in treating obese patients with comorbidities

目的探讨腔镜下Roux-en-Y胃旁路术（1aparoscopic Roux-en-Y gastric bypass，LRYGB）对肥胖症及其合并症的疗效及安全性。方法以23例术前体质量指数（body mass index，BMI）平均35．2kg／m2的肥胖症病人为研究对象，行LRYGB，观察并分析术后BMI、血压、三酰甘油、空腹血糖、糖化血红蛋白等指标的变化情况。结果23例病人均成功接受LRYGB，无术中及术后并发症，随访满12个月。术后病人体重逐渐减低，12个月后BMI平均25．7kg／m2。合并高血压10例，8例于术后3个月血压基本恢复正常；合并高脂血症13例，术后3个月完全缓解；睡眠呼吸暂停综合征13例，术后早期打鼾明显改善，3～6个月症状基本缓解；伴发2型糖尿病15例，术后12个月时10例（66．7％）达到临床完全缓解，3例（20．0％）血糖得到控制，2例（13．3％）血糖得到改善。结论LRYGB对于肥胖症病人体重有大幅、持续的影响，同时可以改善肥胖合并症，尤其对2型糖尿病、高血压、高血脂等具有极好的治疗作用，手术安全，疗效可靠，具有临床推广价值。

Objective To evaluate the safety and efficacies of laparoscopic Roux-en-Y gastric bypass （LRYGB） for obese patients with comorbidities. Methods A total of 23 obese patients （mean body mass index 35.2 kg/m^2 ） underwent LRYGB. The changes of BMI, blood pressure, fasting plasma glucose （FPG）, glycosylated hemoglobin （HbAlc） and triglyceride levels were recorded and analyzed pre- and post- the operations. Results All 23 patients underwent LRYGB successfully and were followed up for 12 months. None of them developed complications. Among 10 patients with hyperten- sion, only two had high diastolic blood pressure at the end of 12 month and required anti-hypertension pills. And 13 patients with hyperlipidemia achieved complete remission at the end of 3 months. For 13 patients with obstructive sleep apnea syndrome, the symptoms improved significantly immediately after operation and showed a virtual remission at the end of 6 month. Among 15 type 2 diabetes mellitus （T2DM） patients, 10 （66. 7%） showed T2DM remission, 3 （20. 0%） had glycemic control and 2 （13.3%） showed improvement at the end of 12 months. Conclusions LYRGB can efficiently and safely treat obese patients with co-morbidities such as T2DM, hypertension, hyperlipemia and obstructive sleep apnea syndrome, etc.