减重代谢手术治疗肥胖合并中重度阻塞性睡眠呼吸暂停低通气综合征术后2年疗效分析

Two-year outcomes of bariatric surgeries for obesity with moderate-severe obstructive sleep apnea-hypopnea syndrome

目的初步探讨腹腔镜胃袖状切除术(LSG)和腹腔镜Roux-en-Y胃旁路术(LRYGB)治疗肥胖合并中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)术后2年疗效。方法回顾性分析上海交通大学医学院附属第九人民医院普外科2016年1月至2019年6月接受LSG或LRYGB的肥胖合并中重度OSAHS病人116例病例资料。根据不同手术方式分为LSG组(77例)和LRYGB组(39例)。比较两组病人术后2年疗效。结果LSG组手术时间低于LRYGB组,而两组间术中出血量和术后住院时间差异均无统计学意义。术前与术后2年两组病人呼吸紊乱指数(AHI)值比较,分别为:LSG组[(64.2±21.6)次/h vs.(13.6±4.1)次/h]和LRYGB组[(59.8±10.5)次/h vs.(12.5±2.4)次/h],差异有统计学意义(P<0.001)。两组术后平均血氧饱和度(SaO_(2))和最低SaO_(2)相较于术前均升高(P<0.001)。而两组间术后2年OSAHS相关各指标(AHI、平均SaO_(2)、最低SaO_(2))比较差异均无统计学意义(P均>0.05)。减重手术治疗OSAHS的临床有效率为100.0%;LSG组的治愈率和显著有效率分别为15.6%和62.3%,LRYGB组的治愈率和显著有效率为15.3%和58.9%;两组间治愈率和显著有效率差异无统计学意义。两组病人术后2年肥胖各指标(体重、BMI、%TWL、颈围、腰围、胸围)均较术前降低(P<0.001),而两组间术后2年肥胖各指标比较差异无统计学意义(P>0.05)。OSAHS病情改善情况与术后颈围下降具有相关性(LSG组:r=0.521,P=0.021;LRYGB组:r=0.4950,P=0.044)。结论LSG和LRYGB能够有效地治疗肥胖合并中重度OSAHS,OSAHS的残余问题需进一步密切随访和开展多学科协助诊治。

Objective To evaluate the 2-year outcomes of laparoscopic sleeve gastrectomy(LSG)and laparoscopic Roux-en-Y gastric bypass(LRYGB)for obesity with moderate-severe obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods The clinical data of 116 obese patients with moderate-severe OSAHS who underwent LSG or LRYGB procedures in Department of Surgery,Shanghai Ninth People’s Hospital,Shanghai JiaoTong University School of Medicine from January 2016 to July 2019 were reviewed retrospectively.According to different surgery methods,they were divided into LSG group(77 cases)and LRYGB group(39 cases).The 2-year outcomes were compared between the two groups.Results The operative time in the LSG group was lower than that in the LRYGB group,and there was no significant difference in intraoperative bleeding and hospital stay between the two groups.The apnea hypopnea index(AHI)of the two groups,dropped from 64.2±21.6/h to 13.6±4.1/h in LSG group and from 59.8±10.5/h to 12.5±2.4/h in LRYGB group respectively,was significant difference(P<0.001).Mean SaO_(2) and minimum SaO_(2) after surgery were increased in both groups compared with preoperative(P<0.001).However,there was no significant difference in the comparison of OSAHS-related indicators(AHI,mean SaO_(2),minimum SaO_(2))between the two groups 2 years after surgery(P>0.05).The clinical effective rate was 100.0%,the significant improvement rate were 62.3%in LSG group and 58.9%in LRYGB group while the cure rate were only 15.6%in LSG group and 15.3%in LRYGB group.There was no significant difference in the efficacy of OSAHS and obesity between the two groups(P>0.05).The indicators of obesity(weight,BMI,%TWL,neck circumference,waist circumference,chest circumference)in the two groups were lower than those before surgery(P<0.001),while there was no significant difference in the indicators of obesity between the two groups 2 years after surgery(P>0.05).Further analysis found that the improvement of OSAHS condition had a correlation with the decrease of postoperative neck circumference(r=0.521,P=0.021 in LSG group vs.r=0.4950,P=0.044 in LRYGB group).Conclusion Both LSG and LRYGB can effectively improve obesity with moderate-severe OSAHS.The OSAHS residual problems require further follow-up and multidisciplinary treatment.