腹腔镜袖状胃切除术治疗不同肥胖程度单纯性肥胖症的疗效分析

Analysis of efficacy of laparoscopic sleeve gastrectomy in treatment of simple obesity with different degrees of obesity

目的探讨腹腔镜袖状胃切除术(LSG)治疗不同肥胖程度单纯性肥胖患者的疗效。方法回顾性收集2016年10月至2018年10月期间在徐州医科大学附属医院接受LSG的患者的临床资料,比较LSG对不同肥胖程度患者术后的减重效果。结果①本研究共纳入符合条件的单纯性肥胖患者161例,其中Ⅰ、Ⅱ、Ⅲ度及超级肥胖患者分别为40、41、61及19例。所有患者手术均顺利完成,无中转开腹及死亡病例。有4例(2.5%)术后发生出血,有97例(60.2%)术后住院期间发生恶心和呕吐。术后1、2、3年随访例数分别为143、130和122例。术后1、2、3年的体质量指数(BMI)值较术前下降明显(P<0.05),术后1、2和3年的多余BMI减少百分比(EBMIL%)分别为(87.4±25.7)%、(84.6±30.5)%、(88.8±20.4)%。术后随访至2年和3年时复胖率分别为3.8%(5/130)、4.9%(6/122)。②不同肥胖程度患者术后1、2、3年的BMI均低于术前(P<0.05);Ⅰ和Ⅱ度肥胖患者术后3年内BMI变化趋势比较稳定,EBMIL%变化值分别为(–2.3±1.1)%、(3.3±1.5)%,Ⅲ度和超级肥胖患者术后3年内的BMI变化趋势则比较明显,EBMIL%变化值分别为(–7.1±1.9)%、(–11.6±5.3)%。结论从本研究结果看,LSG对于治疗Ⅰ和Ⅱ度肥胖患者有良好的减肥效果,对于Ⅲ度和超级肥胖症患者的长期疗效、是否行其他手术方式、是否行第二次手术、二次手术时机选择等问题需要进一步探究。

Objective To evaluate the efficacy of laparoscopic sleeve gastrectomy(LSG)in the treatment of obesity with different degrees of obesity.Methods The clinicopathologic data of patients received LSG in this hospital from October 2016 to October 2018 were analyzed retrospectively.The effect of LSG on postoperative weight loss in patients with different degrees of obesity were analyzed too.Results①A total of 161 patients with simple obesity were included in this study,including 40 cases of degreeⅠobesity,41 cases of degreeⅡobesity,61 cases of degreeⅢobesity,and 19 cases of super obesity.All operations were successfully completed,there was no conversion to laparotomy or mortality.The postoperative bleeding occurred in 4(2.5%)cases,nausea and vomiting occurred in 97(60.2%)cases during hospitalization,and 143,130,and 122 cases were followed up in 1-,2-,and 3-year after operation.The body mass indexes(BMIs)were decreased significantly in postoperative 1-,2-,and 3-year(P<0.05)as compared with their preoperative values,respectively.The excess BMI loss percentage(EBMIL%)in postoperative 1-,2-,and 3-year were(87.4±25.7)%,(84.6±30.5)%,and(88.8±20.4)%,respectively.The rates of weight regaining were 3.8%(5/130)and 4.9%(6/122)in 2-and3-year following-up,respectively.②There were no remarkable changes in the trend of BMI in patients with degreeⅠandⅡobesity[the EBMIL%changes from postoperative year-1 to year-3 were(–2.3±1.1)%and(3.3±1.5)%,respectively].Conversely,there were remarkable changes in the trend of BMI in patients with degreeⅢobesity and super obesity[the EBMIL%changes from postoperative year-1 to year-3 were(–7.1±1.9)%and(–11.6±5.3)%,respectively].Conclusions From the results of this study,LSG has a good effect on weight loss in the treatment of patients with degreeⅠandⅡobesity.The long-term efficacy of LSG in patients with degreeⅢand super obesity,whether to take other bariatric procedures,whether to perform the second operation,and the timing of the second operation need to be further explored.