超级肥胖患者腹腔镜袖状胃切除术的疗效分析与经验分享

Therapeutic effect analysis and experience sharing of treatment on super obesity patients by laparoscopic sleeve gastrectomy

目的探讨腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)治疗超级肥胖症(指体质量指数≥50 kg/m2)的临床疗效及经验。方法回顾性分析2013年5月至2015年5月在广州军区广州总医院甲乳糖尿病外科及广州中医药大学金沙洲医院接受LSG手术的17例随访满1年的超级肥胖症患者的物理指标、多余体质量下降百分比(percentage of excess weight loss,EWL%)及肥胖相关代谢指标。结果 17例患者均顺利完成手术,无中转开腹及死亡患者。手术时间70~278 min,平均(140.4±56.8)min;术中出血量20~200 ml,平均(65.0±44.7)ml;术后进食时间2~5 d,平均(2.5±0.2)d;术后住院时间7~24 d,平均(12.8±4.1)d。术后1年患者EWL%(87.1±25.7)%、物理指标均有明显下降,差异有统计学意义(P<0.01),肥胖相关代谢指标中血三酰甘油、血尿酸及尿微量白蛋白均有明显下降,差异有统计学意义(P<0.01),无严重并发症。结论 LSG作为一种独立的减重术式对超级肥胖症患者有良好的减重效果,具有调脂降尿酸的作用,多学科团队协作模式、术前充分准备、术中麻醉配合、手术经验和技巧、术后饮食管理是围手术期安全的重要保证。

Objective To evaluate therapeutic effect and sharing experience of laparoscopic sleeve gastrectomy on super obesity patients （BMI 〉 50 kg/m2）. Methods Clinical retrospective review of 17 patients of super obesity with 1 year follow-up of physical indexs, EWL% and metabolic indexes between May. 2013 , and May. 2015 in Thyroid and Diabetes Surgery Center, General Hospital of Guangzhou Military Command of PLA and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. Results Operations were successfully performed in all the 17 patients with no mortality. The operative time 70-278 min, （ 140.4 ± 56.8） rain, blood loss 20-200 ml, （65.0 ± 44.7） ml, early postoperative feeding time 2-5 d,（2.5± 0.2）d, and postoperative hospital stay 7-24 d, （12.8 ±4.1）d. During 1 year after operation, there were significant（ P 〈 0.01 ） improvement upon physical indexs, EWL% （87.1 ±25.7 ）% , and the TC, serum uric acid and microalbumin of metabolic indexes. Conclusions Laparoscopic sleeve gastrectomy as a individual operating methods exhibits an effeetive result to super obesity patients, also reduse the serum lipid and uric acid concentration. The Multi Disciplinary Treatment, preoperative management, sophisticated surgical techniques, co-operating with operating room and anesthesiology department, postoperatiue period, post-operative guidelines of nutriology and follow-up visit iscritical to surgical safety and operation curative effect.