三孔法腹腔镜胃袖状切除术治疗极重度肥胖合并心肌病的应用体会

Application of three-incision laparoscopic sleeve gastrectomy in the treatment of extremely severe obesity combined with cardiomyopathy

目的:探讨极重度肥胖合并心肌病的标准化治疗方案。方法:收集2016年1月1日至2019年6月1日诊断为极重度肥胖合并心肌病的6例患者的临床资料,回顾分析其诊疗流程及结果。结果:6例患者均行三孔法腹腔镜胃袖状切除术并顺利出院,1例于术后2个月死亡,考虑肺栓塞;4例出现胆囊结石;2例术后脱发明显。入组患者术后1个月、3个月、6个月、12个月多余体重指数减少百分比分别为(14.19±7.74)%、(20.28±8.05)%、(24.56±12.48)%、(34.92±10.52)%;射血分数术前平均为(25.50±4.53)%,术后1个月、3个月、6个月、12个月分别为(30.42±6.77)%、(34.85±3.98)%、(41.56±7.23)%、(48.71±7.56)%,患者心脏功能较前明显改善。结论:极重度肥胖合并心肌病患者的治疗需要代谢外科医生引领方向,采用多学科合作,应用快速康复理念,三孔法腹腔镜技术可作为较好的选择。

Objective:To investigate the standardized treatment of extremely severe obesity with cardiomyopathy.Methods:Clinical data of six patients diagnosed as extremely severe obesity with cardiomyopathy during Jan.1,2016 and Jun.1,2019 were collected,and the diagnosis and treatment process and results were retrospectively analyzed.Results:Six patients underwent three-incision laparoscopic sleeve gastrectomy and were discharged successfully,and one of them died in two months after the operation,this patient was considered to be more likely to have pulmonary embolism.Cholecystolithiasis occurred in 4 patients.Hair loss was obvious in 2 patients after the operation.The percentage of decrease in excess body mass index at 1 month,3 months,6 months and 12 months after the surgery were(14.19±7.74)%,(20.28±8.05)%,(24.56±12.48)%and(34.92±10.52)%,respectively.The average ejection fraction before surgery was(25.50±4.53)%,and in 1 month,3 months,6 months and 12 months after the surgery was(30.42±6.77)%,(34.85±3.98)%,(41.56±7.23)%and(48.71±7.56)%,respectively.The cardiac function of the patients significantly improved.Conclusions:The treatment of extremely severe obese patients with cardiomyopathy requires the guidance of metabolic surgeons,the escort of multi-disciplinary team and the help of enhanced recovery after surgery.For patients with extremely severe obesity combined with cardiomyopathy,three-incision laparoscopy is a better choice.