不同入路腹腔镜袖状胃切除术用于肥胖症合并2型糖尿病的效果

Effect of different approaches of laparoscopic sleeve gastrectomy for obesity with type 2 diabetes mellitus

目的探究不同入路腹腔镜袖状胃切除术(LSG)在肥胖症合并2型糖尿病(T2DM)患者治疗中的应用价值。方法回顾性分析2021年1月至2023年1月158例行LSG的肥胖症合并T2DM患者资料,依据手术入路不同分为两组,每组各79例。观察组采用比基尼线切口入路实施手术,对照组行常规切口实施手术。采用SPSS 22.0版统计学软件包进行数据分析,围手术期相关指标、炎症应激指标[去甲肾上腺素(NE)、皮质醇(COR)、C反应蛋白(CRP)、白细胞介素(IL-6)]、糖脂代谢指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)]、体重指数(BMI)和切口美观满意度(CS)评分等计量资料以(x±s)表示,行独立样本t检验。计数资料额外增加孔数及并发症用百分比表示,采用χ^(2)检验。P<0.05表示差异具有统计学意义。结果观察组额外增加孔数少于对照组,患者术后排气时间及住院天数短于对照组(P<0.05);观察组患者术后1 d、3 d血清COR、NE、CRP、IL-6水平较对照组低(P<0.05);术后1个月、3个月两组患者糖脂代谢指标FPG、HbAlc、TG、TC水平及BMI间差异无统计学意义(P>0.05);术后3个月观察组患者CS评分较对照组高(P<0.05);两组并发症总发生率差异无统计学意义(P>0.05)。结论比基尼线切口入路与常规切口入路行LSG均是肥胖症合并T2DM安全有效的治疗方式,可促进糖脂代谢,减轻患者体重,但前者能减轻组织损伤,促进患者术后早期恢复,切口美观效果更显著。

Objective To explore the application value of different approaches of laparoscopic sleeve gastrectomy(LSG)in the treatment of obesity patients with type 2 diabetes mellitus(T2DM).Methods The data of 158 obese patients with T2 DM who underwent LSG from January 2021 to January 2023 were retrospectively analyzed.They were divided into two groups according to different surgical approaches,with 79 cases in each group.The observation group was treated with bikini line incision approach,and the control group was treated with routine incision.SPSS 22.0 statistical software package was used for data analysis.Measurement data such as perioperative related indicators,inflammatory stress indicators[norepinephrine(NE),cortisol(COR),C-reactive protein(CRP),interleukin(IL-6)],glucose and lipid metabolism indicators[fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),triglyceride(TG),total cholesterol(TC)],body mass index(BMI)and incision aesthetic satisfaction(CS)scores were expressed as(x±s),and independent t test.The number of additional holes and complications of the count data were expressed as a percentage,and theχ^(2) test was used.P<0.05 indicated that the difference was statistically significant.P<0.05 indicated that the difference was statistically significant.The baseline data of the two groups were collected.The operation and postoperative recovery indexes,inflammatory stress indexes,glucose and lipid metabolism indexes,body mass index(BMI)before and after surgery and cosmetic score(CS),complications were observed.Results The number of additional holes in the observation group was less than that in the control group,and the postoperative exhaust time and hospitalization days were shorter than those in the control group(P<0.05).The levels of serum COR,NE,CRP and IL-6 in the observation group were lower than those in the control group at 1 d and 3 d after operation(P<0.05).There was no significant difference in FPG,HbAlc,TG,TC and BMI between the two groups at 1 month and 3 months after operation(P>0.05).The CS score of the observation group was higher than that of the control group at 3 months after operation(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Both the bikini line incision approach and the conventional incision approach for LSG are safe and effective treatments for obesity with T2DM,which can promote glucose and lipid metabolism and reduce the weight of patients.However,the former can reduce tissue damage and promote early postoperative recovery,and the incision is more beautiful.