10~21岁病态肥胖患者行腹腔镜袖状胃切除术的疗效分析

Efficacy analysis of laparoscopic sleeve gastrectomy in morbidly obese patients aged 10-21 years

目的探讨10~21岁病态肥胖患者行腹腔镜袖状胃切除手术(LSG)的疗效。方法回顾性分析2015年1月至2020年12月期间,暨南大学附属第一医院胃肠外科/减重中心行LSG 200例,对其中10~21岁病态肥胖患者89例(44.5%)的临床资料进行回顾性分析。主要观察指标为SG手术完成情况、围手术期间并发症发生情况和术后3、6、12及≥24个月时的减重相关指标以及糖代谢、血脂代谢、维生素、肝功能及其他生化指标检测结果,并与术前进行比较。符合正态分布的计量资料以x±s表示;由于每个随访时间点的例数与术前例数均不一致,故组间比较仍采用独立样本t检验;非正态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较仍采用Mann-Whitney U检验。结果889例患者中男性35例(39.3%),年龄(18±2)岁;体质指数(38.5±4.8)kg/m^(2),>40 kg/m^(2)者37例;合并有脂肪肝63例(70.8%),高尿酸血症34例(38.2%),睡眠呼吸暂停综合征31例(34.8%),胃食管反流20例(22.4%),2型糖尿病8例(8.9%),高血压2例(2.2%)。89例患者均顺利完成LSG手术,无中转开腹。围手术期未出现大出血、胃漏以及感染病例;术后短期内出现明显的恶心、呕吐及疼痛症状,多于术后第2天可以缓解。术后3、6及12个月的体质指数值分别下降至(31.5±5.8)kg/m^(2)、(28.6±4.3)kg/m^(2)和(26.3±4.4)kg/m^(2),与术前相比,差异有统计学意义(均P<0.05)。术后12个月及≥24个月时,总体质量减少百分比(%TWL)分别为(31.3±9.3)%和(33.1±10.5)%,与术后3个月时(20.5±5.1)%相比,差异有统计学意义(均P<0.05)。多余体质量减少百分比(%EWL)术后12个月及≥24个月时分别为91%(70%,113%)和95%(74%,118%),与术后3个月时的56%(45%,72%)相比,差异也有统计学意义(均P<0.05)。丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)检测水平分别由术前的44.4(25.5,100.5)U/L和29.0(9.5,48.0)U/L下降到≥24个月时的14.0(10.8,18.3)U/L和13.0(10.5,17.3)U/L,糖化血红蛋白由术前5.6(5.3,5.8)%下降到术后≥24个月时的5.3(5.0,5.4)%;高密度脂蛋白则由术前1.0(0.9,1.2)mmol/L增加到术后≥24个月时的1.4(1.1,1.6)mmol/L;维生素B12由术前350.0(256.8,441.3)μg/L下降到术后≥24个月时的230.3(195.4,263.9)μg/L;与术前相比,差异均有统计学意义(均P<0.05)。结论LSG对于10~21岁的病态性肥胖患者疗效良好,但仍需要长期的多中心的随机对照试验进一步证实。

Objective To investigate the efficacy of laparoscopic sleeve gastrectomy(LSG)in morbidly obese patients aged 10 to 21 years.Methods We conducted a retrospective analysis of clinical data from 89 out of 200 patients who underwent LSG at the Gastrointestinal Surgery/Weight Loss Center of the First Affiliated Hospital of Jinan University between January 2015 and December 2020.The primary outcome measures were the completion rate of LSG,the incidence of perioperative complications,and weight-related indicators 3,6,12,and≥24 months postoperatively.Additionally,we compared glucose metabolism,lipid metabolism,vitamin levels,liver function,and other relevant biochemical variables before and after surgery.Normally distributed continuous data are presented as x±s.Because the numbers of patients at each follow-up time point were not identical with the number of patients in the study cohort preoperatively,independent sample t-tests were used for intergroup comparisons.Non-normally distributed continuous data are presented as M(Q_(1),Q_(3)),and Mann-Whitney U tests were used for intergroup comparisons.Results Among the 89 patients,35 were male(39.3%),the mean age was(18±2)years,and mean body mass index(BMI)38.5±4.8 kg/m^(2);37 of the patients having a BMI greater than 40 kg/m^(2).Additionally,63 patients(70.8%)had fatty livers,34(38.2%)hyperuricemia,31(34.8%)sleep apnea syndrome,20(22.4%)gastroesophageal reflux,eight(8.9%)type 2 diabetes,and two(2.2%)hypertension.All 89 patients underwent LSG surgery successfully,with no conversions to open surgery.During the perioperative period,there were no cases of major bleeding,gastric leakage,or infections.Notable postoperative symptoms included nausea,vomiting,and pain,most of which improved by the second postoperative day.BMI values 3,6,and 12 months postoperatively had decreased to 31.5±5.8 kg/m^(2),28.6±4.3 kg/m^(2),and 26.3±4.4 kg/m^(2),respectively.All of these BMI values differed significantly from preoperative values(all P<0.05).At 12 and≥24 months postoperatively,the percentages of total weight loss were(31.3±9.3)%and(33.1±10.5)%,respectively,both differing significantly from 3 months postoperatively(20.5±5.1)%(all P<0.05).The percentages of excess weight loss at 12 and≥24 months postoperatively were 91%(70%,113%)and 95%(74%,118%),respectively,both differing significantly from the percentage of total weight loss 3 months postoperatively(56%[45%,72%])(both P<0.05).Alanine transaminase and aspartate transaminase serum concentrations decreased from preoperative values of 44.4(25.5,100.5)U/L and 29.0(9.5,48.0)U/L to 14.0(10.8,18.3)U/L and 13.0(10.5,17.3)U/L,respectively,≥24 months postoperatively.Hemoglobin A1c decreased from 5.6(5.3,5.8)%preoperatively to≥24 months postoperatively 5.3(5.0,5.4)%.High-density lipoprotein increased from 1.0(0.9,1.2)mmol/L preoperatively to 1.4(1.1,1.6)mmol/L≥24 months postoperatively.Vitamin B12 decreased from 350.0(256.8,441.3)μg/L preoperative to 230.3(195.4,263.9)μg/L≥24 months postoperatively.All differed significantly from preoperative values(all P<0.05).Conclusion LSG has favorable efficacy in morbidly obese patients aged 10 to 21 years.However,further confirmation is required through long-term,multicenter,randomized,controlled trials.