减重代谢手术治疗肥胖合并重度阻塞性睡眠呼吸暂停短期疗效分析

Short-term efficacy of metabolic surgery for obesity with obstructive sleep apnea

目的分析和比较腹腔镜胃袖状切除术(LSG)和腹腔镜胃旁路手术(LRYGB)对肥胖合并重度阻塞性睡眠呼吸暂停(OSA)病人的短期治疗效果。方法回顾性分析上海交通大学医学院附属第九人民医院普外科2016年1月至2017年1月收治的52例肥胖合并重度OSA并接受减重代谢手术病人的临床资料,按手术方式分为LSG组(32例)和LRYGB(20例),评估手术风险以及手术对体重、OSA病情的影响。结果术后短期随访6个月,两组病人均无严重并发症发生。LSG组与LRYGB组两组手术时间、术中失血量和住院时间差异有统计学意义(P<0.01)术后两组肥胖和OSA病情均有缓解,其中LSG组术后6个月呼吸暂停低通气指数(AHI)与术前AHI差异有统计学意义[(25.9±7.8)次/h vs.(69.7±11.4)次/h,P<0.05];LRYGB组术后AHI与术前AHI相比差异有统计学意义[(24.9±6.7)次/h vs.(66.8±10.5)次/h,P<0.05],而两组间差异无统计学意义(P>0.05)。术前AHI可能是影响减重手术治疗肥胖合并OSA疗效的独立影响因素。结论 LSG和LRYGB均可以有效治疗肥胖合并重度OSA的病情,短期疗效明显,长期效果仍待观察研究。

Objective To evaluate the short-term effect of laparoscopic sleeve astrectomy（LSG）and laparoscopic Roux-en-Y gastric bypass （LRYGB） for obesity with OSA. Methods The clinical data of 52 obese patients with OSA performed metabolic ＆ bariatric surgery between January 2016 and January 2017 in Department of General Surgery,Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine were analyzed retrospectively. Patients were divided into two groups（LRYGB group and LSG group）by the procedure they underwent. All patients were assessed as part of a routine follow-up program in the outpatient clinic according to national guidelines and were seen on a regular schedule of 3 and 6 months postoperatively. Results Operations were successfully performed in all the 52 patients with no serious complication in both group. There were significant differences in blood loss,operation time and duration of hospitalization between two groups（P〈0.01）. Six months after operation,there was significant improvement in BMIand AHI in both groups（P〈0.01）. AHI changes from （69.7±11.4） times/h to （25.9±7.8） times/h in LSG group and （66.8±10.5） times/h to （24.9±6.7） times/h in LRYGB group. No significant different between the two groups（P〉0.05）. Meanwhile,preoperative AHI might be the independent factors for the efficacy of MBS for obesity with OSA. Conclusion LSG and LRYGB can improve either obese or OSA condition within 6 months. Long-term outcome is needed for further study.