胃旁路术和袖状胃切除术对重度肥胖患者疗效对比分析

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on morbidly obesity

目的回顾性分析腹腔镜下胃旁路术（1aparoscopic Roux—en—Y gastric bypass，LRYGB）与袖状胃切除术（laparoscopic sleeve gastrectomy，LSG）对病态肥胖患者（BMI≥35kg／m^2）体重控制的手术疗效。方法选取2013年12月至2015年12月行腹腔镜减重手术（LRYGB与LSG）的病态肥胖患者48例，进行1年临床随访研究，对比肥胖相关的一般状况及生化指标，观察2种不同的手术方式对病态肥胖患者的手术疗效。结果LRYGB组20例，LSG组28例。术后6个月LRYGB组多余体重下降百分比（％EWL）高于LSG组（（73±0．04）vs（59±0．05，P=0．03）），术后12个月2组EWL差异无统计学意义。术后1年LRYGB组的低密度脂蛋白水平显著低于ISG组（（2．42±0．16）vs（3．29±0．20，P=0．006））；叶酸水平显著高于袖状胃切除组（（15．58±1．99）vs（7．59±1．59），P=0．022））。结论2种手术术后1年随访资料可看出，在单纯控制体重方面比较，2种手术疗效无明显差异。肥胖相关疾病及营养状况方面，LRYGB组略优于LSG组。但这只是重度肥胖患者短期的术后疗效，长期体重控制效果及肥胖相关疾病的控制仍有待进一步探究。

Objective To evaluate the effects of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy on weight control in morbidly obese patients. Methods 48 patients with morbidly obesity underwent obese surgery （laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy） from Dec. 2013 to Dec. 2015, and 1-year follow-up study. The general situation of obesity and biochemical indicators were com- pared and analyzed. Results There were 20 cases in gastric bypass group and 28 cases in sleeve gastreetomy group.The excess weight loss percentage（%EWL）was 73＋0.04 in gastric bypass group and 59±0.05 in sleeve gastrectomy group（P=-0.03）. There was no statistical difference in weight change between the two groups. Low density lipoprotein cholesterol （LDL） level in gastric bypass group was significantly lower than that in sleeve gastrectomy group at 1 year after surgery （2.42±0.16 vs 3.29±0.20, P=0.006）, while folic acid level was significantly higher than that in sleeve gastrectomy group（15.58±1.99 vs 7.59±1.59,P=0.022）. Conclusions The one-year foUow up shows there is no significant difference in the efficacy of weight control between the two groups. Gastric bypass group may be superior to gastreetomy group in nutrition indexes. However, it is just a short-term postoperative efficacy in morbidly obese patients, long-term weight control effects and obesity related diseases control need to be further explored.