腹腔镜胆胰转流十二指肠转位术治疗肥胖症的临床疗效

Clinical efficacy of laparoscopic biliopancreatic diversion with duodenal switch for obesity

目的探讨腹腔镜胆胰转流十二指肠转位术(BPD‑DS)治疗肥胖症的临床疗效。方法采用回顾性描述性研究方法。收集2019年9月至2020年1月吉林大学中日联谊医院收治的10例肥胖症病人的临床资料;男7例,女3例;年龄为(32±9)岁。病人均行腹腔镜BPD‑DS。观察指标:(1)术中和术后情况。(2)随访情况。采用电话和微信方式随访,了解病人术后3个月、6个月并发症,体格相关指标,术前合并症缓解情况以及血液生化指标。随访时间截至2020年7月。正态分布的计量资料以x±s表示,组间比较采用t检验;重复测量数据采用重复测量方差分析,两两比较采用LSD法。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ^(2)检验。结果(1)术中和术后情况:10例病人均顺利行腹腔镜BPD‑DS,其中1例因胆囊结石同时行胆囊切除术。10例病人术中未见明显出血,无中转开腹及围手术期死亡,手术时间为(256±28)min,术后住院时间为11 d(4~38 d)。2例病人术后发生并发症。(2)随访情况:10例病人均获得术后6个月随访。随访期间,3例病人大便次数明显增多,大便频次为3~5次/d;7例病人大便频次为1~2次/d。10例病人中,4例术后胆汁淤积,2例新发胆囊结石,4例未见异常。10例病人术前体质量、体质量指数、腰围分别为(139±22)kg、(46±10)kg/m2、(139±14)cm;术后3个月上述指标分别为(107±19)kg、(35±8)kg/m2、(118±17)cm;术后6个月上述指标分别为(92±17)kg、(30±6)kg/m2、(104±12)cm,术前与术后上述指标比较,差异均有统计学意义(F=170.01,104.42,120.25,P<0.05)。10例病人术后3个月和术后6个月的多余体质量减少率分别为58%±36%和81%±42%,两者比较,差异有统计学意义(t=73.00,P<0.05)。10例病人中,术前合并2型糖尿病、高三酰甘油血症、高胆固醇血症、高低密度脂蛋白胆固醇、高尿酸血症、高血压病分别为5、4、6、8、9、9例,术后3个月完全缓解分别为4、2、5、5、1、1例,术后6个月完全缓解分别为5、3、4、6、7、5例。术后3个月和6个月高血压病部分缓解病人分别为8例和4例。5例术前合并2型糖尿病病人术前空腹血糖和糖化血红蛋白分别为(11.4±3.1)mmol/L和9.3%±1.6%,术后3个月上述指标分别为(5.6±1.0)mmol/L和5.5%±0.5%,术后6个月上述指标分别为(4.9±0.5)mmol/L和4.8%±0.5%,术前与术后上述指标比较,差异均有统计学意义(F=14.55,39.84,P<0.05)。10例病人视黄醇结合蛋白、维生素E、血清铁、血清锌术前检测值均正常;术后3个月上述指标分别有5、2、1、1例缺乏;术后6个月上述指标分别有3、3、2、4例缺乏;上述营养素缺乏病人均无相应临床症状。10例病人术前维生素A缺乏、低钙血症、叶酸缺乏分别为2、2、0例;术后3个月上述指标分别有5、0、0例缺乏;术后6个月上述指标分别有3、0、1例缺乏。10例病人术前及术后均未发生维生素D、维生素B12及铁蛋白缺乏,均无贫血。结论腹腔镜BPD‑DS治疗肥胖症安全、有效。

Objective To investigate the clinical efficacy of laparoscopic biliopancreatic diversion with duodenal switch(BPD-DS)for obesity.Methods The retrospective and descriptive study was conducted.The clinical data of 10 patients with obesity who were admitted to the ChinaJapan Union Hospital Affiliated to Jilin University from September 2019 to January 2020 were collected.There were 7 male and 3 females,aged(32±9)years.Patients underwent laparoscopic BPDDS.Observation indicators:(1)intraoperative and postoperative situations;(2)follow-up.Follow-up was performed by telephone interview and wechat up to July 2020,to detect complications,physical index,remission of preoperative comorbidity and blood biochemical index at 3 months and 6 months after operation.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Repeated data were analyzed using the repeated ANOVA and pariwise comparison was done using the LSD method.Measurement data with skewed distribution were represented as M(range).Count data were represented as absolute numbers,and comparison between groups was analyzed using the chi-suqare test.Results(1)Intraoperative and postoperative situations:10 patients underwent successfully laparoscopic BPDDS,including 1 patient undergoing concomitant cholecystectomy due to gallstone disease.There was no obvious hemorrhage,conversion to open surgery or perioperative death for the 10 patients.The operation time and duration of postoperative hospital stay were(256±28)minutes and 11 days(range,4−38 days).Two patients had postoperative complications.(2)Follow-up:10 patients were followed up for 6 months.During the follow-up,3 patients had increased frequency of defecation,with 3−5 times per day,7 patients had defecation frequency of 1−2 times per day.Of 10 patients,4 cases had postoperative cholestasis,2 cases development to gallstone,and the remaining 4 patients had no abnor-mality.The body weight,body mass index,waist circumference of 10 patients were(139±22)kg,(46±10)kg/m2,(139±14)cm before operation,(107±19)kg,(35±8)kg/m2,(118±17)cm at 3 months after operation,and(92±17)kg,(30±6)kg/m2,(104±12)cm at 6 months after operation,showing significant differences(F=170.01,104.42,120.25,P<0.05).The excess body mass reduction rates at 3,6 months after operation of 10 patients were 58%±36%and 81%±42%,showing a significant difference(t=73.00,P<0.05).Of 10 patients,cases with type 2 diabetes,hypertriglyceridemia,hypercholesteremia,elevated low density lipoprotein cholesterin level,hyperuricemia,hypertension were 5,4,6,8,9,9 before operation,cases with complete remission were 4,2,5,5,1,1 at 3 months after operation,and cases with complete remission were 5,3,4,6,7,5 at 6 months after operation.Cases with partial remission of hypertension were 8 and 4 at 3,6 months after operation.For 5 patients with type 2 diabetes,the fasting blood glucose and hemoglobin Alc were(11.4±3.1)mmol/L and 9.3%±1.6%before operation,(5.6±1.0)mmol/L and 5.5%±0.5%at 3 months after operation,(4.9±0.5)mmol/L and 4.8%±0.5%at 6 months after operation,showing significant differences(F=14.55,39.84,P<0.05).Of 10 patients,the retinal-binding protein,vitamins E,serum iron,serum zinc were normal before operation,cases with deficiency of above indicators were 5,2,1,1 at 3 months after operation and 3,3,2,4 at 6 months after operation.There was no clinical symptoms in patents with nutrient deficiency.Cases with deficiency of vitamins A,hypocalcemia,folic acid deficiency were 2,2,0 before operation,5,0,0 at 3 months after operation and 3,0,1 at 6 months after operation.No deficiency of vitamins D,vitamins B12,ferritin or anemia occurred to the 10 patients.Conclusion Laparoscopic BPD-DS is safe and effective for obesity.