减重手术治疗肥胖合并非酒精性脂肪性肝病的术后1年疗效评价

Evaluation of one-year effects of metabolic and bariatric surgery on obesity with nonalcoholic fatty liver disease

目的分析比较腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)和腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)对肥胖合并非酒精性脂肪性肝病(nonalcoholic fatty liver,NAFLD)病人的短期临床疗效。方法回顾性分析2016年1月至2018年1月在上海交通大学医学院附属第九人民医院普外科行减重手术的104例肥胖合并NAFLD病人的临床资料,按手术方式分为LSG组(82例)和LRYGB组(22例),术后随访1年,评估手术并发症,分析两种手术方式对体重、糖脂代谢指标、肝功能指标及肝纤维化情况的影响。结果LSG组手术时间和住院时间均短于LRYGB组(P<0.05);两组的术中出血量差异无统计学意义(P>0.05)。与术前相比,术后12个月两组病人的体重、空腹血糖、糖化血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇均显著降低(P<0.05);高密度脂蛋白胆固醇显著增加(P<0.05)。术前肝功能异常者62例,术后12个月两组病人的丙氨酸转氨酶、天冬氨酸转氨酶、γ谷氨酰转移酶等肝功能指标显著降低(P<0.05),完全恢复正常52例(83.9%)。术前存在进展期肝纤维化者14例,术后12个月两组病人的NAFLD纤维化评分显著降低(P<0.05),9例(64.3%)病人已无进展期肝纤维化。术后各项指标两组间差异均无统计学意义(均P>0.05)。结论LSG与LRYGB均可有效治疗肥胖合并NAFLD,近期效果显著,且两种方法治疗效果相近。

Objective To analyze and compare the short-term clinical efficacy of laparoscopic sleeve gastrectomy(LSG)and laparoscopic Roux-en-Y gastric bypass(LRYGB)in obese patients with obesity with nonalcoholic fatty liver disease(NAFLD). Methods The clinical data of104 obese patients with NAFLD who underwent bariatric surgery in the Department of General Surgery,Ninth People's Hospital,Shanghai Jiaotong University School of Medicine from January 2016 to January 2018 were retrospectively analyzed. The patients were divided into LSG group(82 cases)and LRYGB group(22 cases)according to the surgical method. The patients were followed up for1 year to evaluate the surgical complications. The effects of the two surgical methods on body weight,glucose and lipid metabolism indicators,liver function indicators and liver fibrosis were analyzed. Results The duration of operation and postoperative hospital stay in LSG group were shorter compared with those in LRYGB( P <0.05);and there was no significant difference in intraoperative blood loss between groups( P > 0.05 ). At12 months after operation,the mean body mass index(BMI ),fasting plasma glucose(FPG),hemoglobin A1c(HbA1c),total cholesterol(TC),triglyceride(TG),and low density lipoprotein- cholesterol(LDL-C)levels significantly decreased compared with those before surgery( P <0.05);and high density lipoprotein-cholesterol (HDL-C)level increased significantly( P <0.05). In addition,for those with abnormal liver function( n =62),the alanine aminotransferase(ALT),aspartate aminotransferase(AST),and gamma glutamyl transpeptidase(GGT)levels were significantly lower than those before surgery,and 52(83.9%)completely recovered to normal;for those with advanced liver fibrosis( n =14),the NAFLD fibrosis score(NFS)was significantly lower than that before operation,and advanced liver fibrosis.in nine patients(64.3%)has subsided. There was also no significant difference between groups( P >0.05). Conclusion Both LSG and LRYGB were equally effective in the treatment of obesity with NAFLD in the short term.