对称三孔法腹腔镜袖状胃切除术治疗原发性高血压的疗效分析

Therapeutic effect of symmetrical three-port laparoscopic sleeve gastrectomy on essential hypertension

目的:探讨对称三孔法腹腔镜袖状胃切除术治疗肥胖合并原发性高血压的临床疗效。方法:回顾分析2017年4月至2019年9月为65例肥胖合并原发性高血压患者行对称三孔法腹腔镜袖状胃切除术的临床资料,分析患者术后1年血压情况、减重情况及代谢指标的变化,根据术后1年随访结果将患者分为缓解组(n=42)与未缓解组(n=23),寻找术后高血压缓解的独立影响因素。结果:65例患者均顺利完成手术,无严重并发症发生,术后1年体重、体重指数、腰围、收缩压、舒张压、空腹血糖、空腹胰岛素、胰岛素抵抗指数、C肽、甘油三酯、低密度脂蛋白与术前相比差异均有统计学意义(P<0.01);Logistic回归分析结果显示,术前高血压病程、服用抗高血压药物种类数量、高血压分级是原发性高血压预后的独立影响因素。结论:对于肥胖合并原发性高血压的患者,对称三孔法腹腔镜袖状胃切除术减重效果明显,且高血压改善率可达100%,糖脂代谢的相关指标也较术前有明显改善,患者术前高血压病程越短、服用抗高血压药物种类数量越少、高血压分级越低,术后高血压病缓解的可能性越大。

Objective:To evaluate the clinical effect of symmetrical three-port laparoscopic sleeve gastrectomy on obesity with essential hypertension.Methods:A retrospective analysis was performed on the clinical data of 65 obese patients with essential hypertension who underwent symmetrical three-port laparoscopic sleeve gastrectomy from Apr.2017 to Sep.2019.The changes of blood pressure,weight loss and metabolic indexes in 1 year after surgery were analyzed.According to the one-year follow-up results,the patients were divided into remission group(n=42)and no-remission group(n=23)in order to find the independent influencing factors of hypertension remission.Results:All 65 patients completed the surgery successfully without serious complications.There were significant differences in weight,body mass index,waist circumference,systolic blood pressure,diastolic blood pressure,fasting blood glucose,fasting insulin,homeostasis model assessment-insulin resistance,C-peptide,triglyceride and low density lipoprotein in 1 year after surgery compared with those before operation(P<0.01).According to the results of logistic regression analysis,the duration of hypertension before surgery,the number of antihypertensive medication types used,and hypertension grade were independent influencing factors of the hypertension prognosis.Conclusions:For obese patients with essential hypertension,symmetrical three-port laparoscopic sleeve gastrectomy can not only make patients significantly lose weight,but also the improvement rate of hypertension can reach 100%,and the related indicators of glucose and lipid metabolism significantly improve compared with those before surgery.The shorter duration of hypertension before surgery,the fewer number of antihypertensive medication types used,and the lower grade of the preoperative hypertension is,the greater the possibility of postoperative hypertension remission becomes.