胃袖状切除加空肠旁路术在肥胖症的初步应用

Preliminary application for sleeve gastrectomy plus jejunum bypass in the treatment of morbid obesity

目的探讨腹腔镜胃袖状切除联合空肠旁路术(sleeve gastrectomy plus jejunal bypass,LSG+JJB)在治疗肥胖症中的初步应用。方法回顾性分析2014年10月至2016年6月在中山市小榄人民医院接受减重代谢手术治疗的33例肥胖症患者的资料,根据接受手术方式的不同将患者分为腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)组、腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)组及LSG+JJB组:LSG组10例,其中男性1例,女性9例,年龄(35.2±12.6)岁;LRYGB组13例,其中男性5例,女性8例,年龄(39.6±8.8)岁;LSG+JJB组10例,其中男性7例,女性3例,年龄(32.1±7.9)岁。结果术后1个月,LSG+JJB组患者的体质量指数减少量和多余体质量下降百分比(percentage of excess weight loss,EWL%)分别为(5.0±1.2)kg/m^2和(54.7±28.4)%,明显高于LSG组的(2.8±1.9)kg/m^2和(44.0±22.2)%(t=2.658 1,P=0.007 764)。术后3个月,LSG+JJB组患者的体质量指数减少量和EWL%分别为(8.6±2.0)kg/m^2和(37.9±27.6)%,高于LRYGB组的(6.8±2.0)kg/m^2和(31.7±15.1)%(t=1.858,P=0.039)。结论 LSG+JJB相对操作难度不高,简单易行,具有良好的减肥和改善肥胖相关合并症的作用,短期疗效显著,但长期疗效有待于进一步观察。

Objective The objective of this study is to explore the preliminary application for laparoscopic sleeve gastrectomy plus jejunum bypass in the treatment of morbid obesity. Methods Bariatric data for 33 cases in the peopled hospital of XiaoLan in Zhongshan city was retrospectively reviewed from Oct. 2014 to Jun. 2016, according to the different surgery methods, patients were divided into laparoscopic sleeve gastrectomy （LSG） group, laparoscopic Roux en -Y gastric bypass （LRYGB） group and LSG ＋ JJB group, there were 10 cases in LSG group （1 male, 9 female） , the average age was （35.2± 12.6 ） years; 13 cases in LRYGB group （5 male, 8 female） , average age was （39.6 ± 8.8） years; 10 cases in LSG ＋ JJB group （7 male, 3 female） , average age was （32.1± 7. 9） years. Results One month after surgery, the body mass index （ BMI） decrease and the excess weight loss （ EWL% ） in LSG＋JJB group were （5.0±1.2 ） kg/m2 and （ 54. 7± 28.4 ） % respectively,higher than those in LSG group which were （2.8 ± 1.9） kg/m2 and （44. 0 ±22.2）%（t= 2. 658 1 ,P =0. 007764） ; Three month after surgery,the BMI decrease and the EWL% in LSG ＋ JJB group were （8. 6 ± 2. 0） kg/m2 and （37.9 ± 27. 6）% respectively, higher than those in LRYGB group which were （6.8±2.0 ） kg/m2 an d（31. 7±15.1） % （t =1.858 ,P=0. 039） . Conclusions Our study showed that LSG ＋ JJB operation was not very difficult to conduct, which had better effect on weight loss and obesity related complications improvement, the efficacy of short-term was obvious, however, the long-term effect of this technique needs to be further observed.