代谢外科手术治疗青少年肥胖症患者的临床疗效

Clinical efficacy of metabolic surgery on obese adolescents

目的 探讨代谢外科手术治疗青少年肥胖症患者的临床疗效.方法 回顾性分析2010年6月至2014年1月南京医科大学第一附属医院收治的28例青少年肥胖症患者的临床资料.手术方式根据患者个人意愿行胃旁路术或胃袖状切除术.术后1、3、6、9个月定期随访,随访时间截至2014年10月.观察患者围术期情况和术后疗效.正态分布的计量资料以-x±s表示,不同手术减重效果的趋势比较采用重复测量方差分析.结果 28例患者手术均在腹腔镜下完成,其中行胃旁路术16例,胃袖状切除术12例.平均手术时间为136.5 min（60.0～320.0 min）,术后平均住院时间为4 d（2 ～8 d）.围术期3例患者出现并发症,无严重并发症及死亡患者.28例患者均获得术后随访;术后1、3、6、9个月平均BMI分别为36.1、33.2、30.2、28.4 kg/m2,平均多余体质量减少率（EWL）分别为24.6％、40.4％、55.1％、63.9％.胃旁路术患者术前及术后1、3、6、9个月BMI分别为（43±6）kg/m2、（37±5）kg/m2、（34 ±4）kg/ru2、（30±4）kg/m2、（29±4）kg/m2,胃袖状切除术患者分别为（39±4）kg/m2、（35±4）kg/m2、（32 ±5）kg/m2、（31±4） kg/m2、（28 ±4） kg/m2;胃旁路术患者术后1、3、6、9个月EWL分别为24％±9％、40％±9％、59％±12％、65％±12％,胃袖状切除术患者分别为25％±9％、41％±15％、49％ ± 16％、63％±17％.胃旁路与胃袖状切除术后减重效果比较,BMI、EWL变化差异均无统计学意义（F =0.777,0.332,P＞0.05）.随访期间4例患者出现营养并发症,均为胃旁路术后患者,经对症处理后好转.结论 代谢外科手术治疗青少年肥胖症患者安全可行,减重效果显著,但远期有可能出现营养并发症,需要长期的随访及营养干预,具体手术方式的选择应遵循个体化原则.

Objective To explore the clinical effects of metabolic surgery on obese adolescents.Methods The clinical data of 28 obese adolescents who were admitted to the First Affiliated Hospital of Nanjing Medical University from June 2010 to January 2014 were retrospectively analyzed.Patients underwent gastric bypass and sleeve gastrectomy according to their own intention and were followed up regularly at 1,3,6,9 months after surgery till October 2014.The perioperative conditions and postoperative effecacies of patients were observed.The measurement data with normal distribution were presented as-x ± s,the comparisons of weight-loss trends among different surgeries were analyzed by the repeated measures ANOVA.Results All surgeries were performed under laparoscope without severe complications or deaths,including 16 cases of gastric bypass and 12 cases of sleeve gastrectomy.The median operation time and duration of postoperative stay were 136.5 minutes （range,60.0-320.0 minutes） and 4 days （range,2-8 days）,respectively.Three patients had perioperative complications.All patients received postoperative follow-ups.The median body mass index（BMI） at postoperative month 1,3,6,9 were 36.1 kg/m2,33.2 kg/m2,30.2 kg/m2 and 28.4 kg/m2,and mean excess weight loss （EWL） rate were 24.6%,40.4%,55.1% and 63.9%.The BMIs before operation and at postoperative month 1,3,6,9 were （43 ± 6） kg/m2,（37 ± 5） kg/m2,（34 ± 4） kg/m2,（30 ± 4） kg/m2 and （29 ± 4） kg/m2 in patients undergoing gastric bypass,and （39±4）kg/m2,（35±4）kg/m2,（32 ±5）kg/m2,（31 ±4）kg/m2 and （28 ±4）kg/m2 in patients undergoing sleeve gastrectomy,respectively.The EWL at postoperative month 1,3,6,9 were 24% ± 9%,40%±9%,59% ± 12% and 65% ± 12% in patients undergoing gastric bypass,and 25% ±9%,41% ± 15%,49% ± 16% and 63% ± 17% in patients undergoing sleeve gastrectomy,respectively.There was no difference in the change of BMI and EWL between gastric bypass and sleeve gastrectomy （F =0.777,0.332,P 〉 0.05）.Four patients undergoing gastric bypass were found to have nutritional complications in follow-up and recovered after symptomatic treatment.Concltsion Bariatric surgery is safe and feasible for obese adolescents with a significant weight loss.However relevant nutrition complications may occur,it is significant to sustain a long-term followup and nutrition intervention,and the choice of surgical procedures should follow the principle of individuation.