腹腔镜胃束带联合胃折叠术后一年随访研究

One-year follow-up study of adjustable gastric banded plication for the treatment of obesity and metabolic diseases

目的探讨腹腔镜胃束带联合胃折叠术在减重,改善糖脂代谢、胰岛功能和肥胖相关合并症方面的疗效。方法回顾性分析2012年4月至2014年6月在广州医科大学附属第一医院接受胃束带联合胃折叠术的15例未合并2型糖尿病的肥胖症患者的临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男6例,女9例;平均年龄(29±8)岁,平均病程(15±9)年,平均体质指数(42±7)kg/m^2,平均糖化血红蛋白(5.7±0.3)%,合并高血压病4例、脂代谢紊乱12例、脂肪肝11例、月经异常6例、阻塞性睡眠呼吸暂停综合征8例。术后第1、3、6、12个月对患者进行人体测量指标、糖脂代谢指标、血压、脂肪肝、月经、打鼾和用药等方面的观察比较。手术前后指标的比较采用t检验。结果术后1年,患者的平均体重、空腹血糖、胰岛素抵抗指数均较术前明显降低(t=9.368,P<0.05;t=3.118,P<0.05;t=6.515,P<0.05),肥胖症合并的高血压病、脂代谢紊乱、脂肪肝、月经异常、睡眠呼吸暂停综合征等也得到明显改善,缓解率在50%以上。结论对于病态性肥胖症患者,胃束带联合胃折叠术在减轻体重和改善总体代谢紊乱方面疗效显著。

Objective To investigate the curative effects of laparoscopic gastric banded plication on reduing weight, improving glucose and lipid metabolism, improving islet function and obesity related complications. Methods Clinical data of 15 obese patients without type 2 diabetes mellitus undergoing laparoscopic gastric banded plication in the First Affiliated Hospital of Guangzhou Medical University between April 2012 and December 2014 were studied retrospectively. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 15 patients, 6 were males and 9 were females with an average age of(29±8) years old, an average disease course of(15±9) years, an average body mass index of(42±7) kg/m^2 and an average glycated hemoglobin A1 c of(5.7±0.3)%. Besides that, 4 patients had hypertension, 12 had lipid metabolic disorder, 11 had fatty liver, 6 had menstrual disorder and 8 had sleep apnea syndrome. The anthropometric parameters, glucose and lipid metabolic index, blood pressure, fatty liver, menstruation, snore and medication were observed and compared at 1, 3, 6 and 12 months postoperatively. Clinical indexes before and after operations were compared using t test. Results The average body weight, fasting glucose and homeostatic model assessment of insulin resistance of patients 1 year postoperatively were significantly lower than those preoperatively(t=9.368, P<0.05;t=3.118, P<0.05; t=6.515, P<0.05). Hypertension, lipid metabolic disorder, fatty liver, menstrual disorder and sleep apnea syndrome were improved significantly with a remission rate of over 50%. ConclusionAdjustable gastric banded plication has good curative effects in morbidly obese patients on reducing weight and improving metabolic disorders.