中度肥胖患者行袖状胃切除与袖状胃切除联合空肠旁路术的短期效果对比分析

Comparative analysis of short-term effects of sleeve gastrectomy and sleeve gastrectomy combined with jejunal bypass in patients with moderate obesity

目的:探讨中度肥胖患者行腹腔镜袖状胃切除(LSG)联合空肠旁路术(JJB)的减重效果及并发症缓解优势。方法:统计分析2019年1月至2021年11月行减重手术的61例患者的临床资料。采用历史性队列研究,根据手术方式将患者分为两组,其中31例行LSG(LSG组),30例行LSG+JJB(LSG+JJB组)。比较两组患者术前与手术资料、术后6个月减重效果及肥胖并发症缓解情况。结果:两组患者性别、年龄、术前体重、BMI、血压、血糖、血脂指标差异无统计学意义(P>0.05);两组术中出血量、术后排气时间、饮水时间、术后呕吐、术后住院时间及并发症发生率差异均无统计学意义(P>0.05),LSG+JJB组手术时间长于LSG组(P<0.05)。术后6个月,两组体重、BMI、多余体重减少百分比、总体重减少百分比、空腹血糖、糖化血红蛋白、收缩压/舒张压、贫血、低蛋白、胆囊结石、脱发、维生素D、维生素B 12及叶酸缺乏情况差异无统计学意义(P>0.05),LSG+JJB组甘油三酯、胆固醇低于LSG组(P=0.010,P=0.028),腹泻发生率高于LSG组(P=0.020)。结论:对于中度肥胖人群,LSG+JJB仅对高脂血症有明显优势,在减重效果、糖尿病及高血压控制方面无明显优势,中度肥胖人群应谨慎选用。

Objective:To investigate the weight loss effect and complication relief advantages of laparoscopic sleeve gastrectomy(LSG)combined with jejunal bypass(JJB)in moderately obese patients.Methods:The clinical data of patients who underwent metabolic and bariatric surgery from Jan.2019 to Nov.2021 were statistically analyzed in a historical cohort study.Patients were divided into two groups according to different surgical methods,31 cases underwent LSG(LSG group)and 30 cases underwent LSG+JJB(LSG+JJB group).Preoperative and surgical data,weight loss effect and obesity complications remission in 6 months after surgery were compared between the two groups.Results:There was no statistically significant difference between the two groups in terms of gender,age,pre-o perative body weight,BMI,blood pressure,blood glucose,and blood lipid indexes(P>0.05).There was no statistically significant difference between the two groups in terms of intraoperative blood loss,first farting time,water intaking time,postoperative vomiting,postoperative hospital stay and the incidence of complications(P>0.05),and the surgical time of LSG+JJB group was longer than that of the LSG group(P<0.05).At 6 months after surgery,there were no statistically significant differences in body weight,BMI,percentage of excess weight loss,percentage of total weight loss,fasting blood glucose,glycosylated hemoglobin and systolic/diastolic blood p ressure,anemia,low protein,gallstone occurrence,alopecia,deficiency of vitamin D,vitamin B 12 and folic acid between the two groups(P>0.05),but triglyceride and cholesterol in LSG+JJB group was lower than that in LSG group(P=0.010,P=0.028),and the i ncidence of diarrhea in LSG+JJB group was significantly higher than that in LSG group(P=0.020).Conclusions:For moderately obese people,LSG+JJB only has obvious advantages for hyperlipidemia,and there is no obvious advantage in weight loss,control of d iabetes and hypertension.LSG+JJB should be carefully selected in moderately obese people.