腹腔镜袖状胃切除术治疗单纯性肥胖疗效

Analysis of laparoscopic sleeve gastrectomy for obesity

目的探讨腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)对肥胖及肥胖合并疾病的疗效及安全性。方法回顾性分析首都医科大学附属北京天坛医院于2012年7月至2015年9月接受腹腔镜胃袖状切除手术的26例单纯性肥胖病人临床资料。记录术后3、6、12和18个月时体质量指数(body mass index,BMI)及多项生物化学指标等。结果所有病人均顺利完成LSG术,无中转开腹。手术时间50~170 min,平均(79.7±4.7)min;术中出血10~50m L,平均(24.6±1.8)m L;术后住院日为5~13 d,平均(5.9±0.3)d;术后腹腔积液、腹腔出血各1例,无二次手术病例。术后3、6、12、18个月时,多余体质量减少分别为54.9%、62.7%、80.1%和68.4%,随访3~36个月未出现不可控制的体质量下降等恶性营养不良。随访期间出现1例(3.8%)胆囊结石、2例(7.6%)缺铁性贫血、2例(7.6%)胃食管反流症状。术后肥胖相关疾病如糖尿病、高血压、脂肪肝、高脂血症等均有明显改善。结论腹腔镜袖状胃切除术治疗单纯性肥胖症减重效果确切、安全,但其与胃旁路手术等其他减重手术的效果对比尚需进一步研究。

Objective To analyze the effect of laparoscopic sleeve gastrectomy on obesity and its co-related diseases. Methods Totally 26 patients with obesity were undergone laparoscopic sleeve gastrectomy at Beijing Tiantan Hospital, Capital Medical University from July 2012 to September 2015, weight body mass index（BMI） and biochemical indicators of per-operation and 3,6,12 and 18 post-operation was recorded. Results All cases were successfully completed in laparoscopic sleeve gastrectomy without conversion to laparotomy. Mean operative time was （79.7±4.7）min,50-170 min, with mean blood loss of （24.6±1.8）mL,10-50 mL, and mean postoperative hospital stay was （5.9±0.3）days,5-13 days. One seroperitoneum and 1 intra-abdominal hemorrhage occurred postoperative, all treated with expectant treatment. 3,6,12,18 months post-operation excess weight loss （EWL） was 54.9%,62.7%,80.1% and 68.4%. No uncontrolled malnutrition occurred during 3-36 month fellow-up. One gallstone（3.8%）, 2 iron-deficiency anemia（7.6%） and 2 gastroesophageal reflux disease（7.6%） occurred the same time. Co-related diseases such as hypertension, fatty liver, hyperlipidemia, abnormal liver function, hyperuricemia were improved. Conclusion Laparoscopic sleeve gastrectomy is effective on weight control as well as on biochemical indicators and co-related diseases improve in obese patients. Further research is required to compare the effect of sleeve gastrectomy with gastric bypass and other bariatric surgeries.