短胆胰支与占全小肠1/3的长胆胰支单吻合口胃旁路术治疗肥胖症短期疗效的对比研究

Short-term result of one anastomosis gastric bypass using short biliopancreatic limb vs.long biliopancreatic limb which is 1/3 small bowel length

目的比较≤200 cm短胆胰支和占全小肠1/3比例长胆胰支单吻合口胃旁路术(OAGB)治疗肥胖症患者的1年减重效果和术后并发症情况。方法回顾性分析2019年8月-2022年12月期间在苏州大学第一附属医院和苏州明基医院接受OAGB 98例肥胖症患者的临床资料。按胆胰支长度分为两组:胆胰支≤200 cm(S-OAGB)40例,占全小肠1/3比例的长胆胰支(L-OAGB)48例。结果术后1年,S-OAGB组和L-OAGB组在减重指标和代谢合并症缓解率方面比较差异均无统计学意义(均P>0.05);两组的体质量[(68.7±10.7)kg比(68.4±12.5)kg]、BMI[(25.5±3.7)kg/m^(2)比(24.6±3.4)kg/m^(2)]、总体质量减少百分比[(32.1%±6.1%)比(32.6%±9.1%)]、多余体质量减少百分比[(107.2%±29.9%)比(114.8%±46.4%)]、2型糖尿病缓解率(93%比92%)、高血压缓解率(86%比81%)、高脂血症缓解率(66%比66%)、高尿酸血症缓解率(67%比59%)差异均无统计学意义(均P>0.05);S-OAGB组的血清铁(10.8μmol/L比7.8μmol/L)、叶酸(12.8 ng/ml比5.6 ng/ml)和血清总蛋白[(71.7±4.1)g/L比(69.7±4.7)g/L]均高于L-OAGB组,差异均有统计学意义(均P<0.05);两组患者在术后肠梗阻、吻合口狭窄、吻合口溃疡、食管炎、胆汁反流性胃炎、倾倒综合征、胆囊结石等非营养并发症发生情况方面比较差异均无统计学意义(均P>0.05)。结论≤200 cm短胆胰支OAGB具有良好的短期减重效果,同时可以减少营养相关合并症。

Objective To compare the 1-year weight loss effect and postoperative nutritional complications of OAGB in≤200 cm biliopancreatic limb and long biliopancreatic limb taking 1/3 of whole small intestine length.Methods Clinical data of patients who received OAGB at the First Affiliated Hospital of Soochow University and Suzhou BenQ Hospital from Aug 2019 to Dec 2022 were retrospectively collected and divided into two groups according to the length of biliopancreatic limb:40 cases with≤200 cm biliopancreatic limb(S-0AGB)and 48 cases with biliopancreatic limb of 1/3 whole small intestine(L-OAGB).Results One year after surgery,there was no significant difference in weight loss and remission rate of metabolic complications between S-0AGB group and L-0AGB group(all P>0.05):Body mass[(68.7±10.7)kg vs.(68.4±12.5)kg]、BMI[(25.5±3.7)kg/m^(2)vs.(24.6±3.4)kg/m^(2)]、%TWL[(32.1%±6.1%)vs.(32.6%±9.1%)]、%EWL[(107.2%±29.9%)vs.(114.8%±46.4%)],remission rate of type 2 diabetes(93%vs.92%),remission rate of hypertension(86%vs.81%),remission rate of hyperlipidemia(66%vs.66%)and remission rate of hyperuricemia(67%vs.59%)were not significantly different(all P>0.05).While in terms of nutritional complications,serum iron(10.8μmol/L vs.7.8μmol/L),folic acid(12.8 ng/ml vs.5.6 ng/ml)and serum total protein[(71.7±4.1)g/L vs.(69.7±4.7)g/L]in S-0AGB group were better than L-0AGB group,and the difference was statistically significant(all P<0.05).There was no statistical significance in the occurrence of postoperative non-nutritional complications such as intestinal obstruction,anastomotic stenosis,anastomotic ulcer,esophagitis,bile reflux gastritis,dumping syndrome,gallstone between the two groups(all P>0.05).Conclusion≤200 cm short biliary pancreatic branch OAGB has a good short-term weight loss effect,while reducing nutrition-related problems.