腹腔镜袖状胃切除术治疗终末期肾病肥胖患者的疗效分析

Clinical efficacy of laparoscopic sleeve gastrectomy in obese end-stage renal disease on continuous hemodialysis

目的探讨腹腔镜袖状胃切除术治疗终末期肾病肥胖患者的疗效及安全性。方法回顾性分析2018年6月至2023年6月天津市第一中心医院共32例终末期肾病肥胖患者(持续性血液透析)行腹腔镜袖状胃切除术的临床资料(观察组),并选取同期肥胖症患者(无肾功能障碍)34例作为对照组,比较两组患者的围手术期资料,术后3、6个月时的减重效果及代谢合并症缓解情况结果与对照组相比,观察组患者手术时间长[(117±16)min比(108±11)min,t=2.771,P=0.007]、手术出血量多[(25±6)ml比(17±4)ml,t=6.276,P<0.001]、术后引流量多[62(52~71)ml比35(28~40)ml,Z=-6.928,P<0.001]、术后住院时间长[13.5(12~15)d比9(8~10)d,Z=-6.423,P<0.001]。观察组和对照组患者术后并发症发生率分别为16%和6%,差异无统计学意义(χ^(2)=1.650,P=0.170)。观察组患者术前及术后3、6个月体质量分别为(109.84±12.84)、(90.94±10.92)、(80.56±9.13)kg,BMI分别为(38.68±2.66)、(31.84±2.06)、(28.04±1.62)kg/m^(2),差异均有统计学意义(F=568.244、386.675,均P<0.001)。观察组患者术后3个月和6个月的多余体质量减少百分比由43.41%±8.83%增至60.50%±7.27%,差异有统计学意义(t=-10.775,P<0.001)。观察组患者术前和术后6个月的高血压、糖尿病、高脂血症、高尿酸血症患病率分别由75%、47%、34%、44%降至47%、22%、9%、16%,差异均有统计学意义(χ^(2)=5.317,P=0.021;χ^(2)=4.433,P=0.035;χ^(2)=0.032,P=0.027)。结论终末期肾病肥胖患者行腹腔镜袖状胃切除手术是安全有效的,可减少患者多余体质量,改善糖尿病、高脂血症、高血压、高尿酸血症等代谢合并症。

Objective To explore the efficacy and safety of laparoscolzic sleeve gastrectomy on-end-stage renal disease with continuous hemodialysis.Methods Thirty-two end-staged renal disease obese patients underwent laparoscopic sleeve gastreclomy from Jun 2018 to Jun 2023 at Tianjin First Central Hospital were compared to 34 obese patients with normal renal function.Result Compared with the control group,the operation time in treatment group was longer[(117±16)min vs.(108±11)min,t=2.771,P=0.007],the intraoperative blood loss was more[(25±6)ml vs.(17±4)ml,t=6.296,P<0.001],the postoperative drainage volume was more[62(52-71)ml vs.35(28-40)ml,Z=-6.928,P<0.001],the postoperative hospitalization time was longer[13.5(12-15)d vs.9(8-10)d,Z=-6.423,P<0.001].There was no significant difference in overall morbidity between the two groups(16%vs.6%,x=1.650,P=0.170).The body mass was(109.84±12.84)kg,(90.94±10.92)kg,(80.56±9.13)kg,and BMI(38.68±2.66)kg/m^(2),(31.84±2.06)kg/m^(2),(28.04±1.62)kg/m^(2) at preoperative and postoperative 3,6 month respectively in cases of treatmentgroup.The percentages of excess weight loss were 43.41%±8.83%and 60.50%±7.27%at postoperative 3 and 6 months(t=-10.775,P<0.001).Remission rates of metabolic diseases such as high blood presure,diabetis,hyperlipidemia,and hyperuricemia in renal disease group all significantly different at different follow-up points(χ^(2)=5.317,P=0.021;χ^(2)=4.433,P=0.035;χ^(2)=0.032,P=0.027).Conclusions Laparoscopic sleeve gastrectomy has definite clinical efficacy in the treatment of obesity end-stage renal disease by reducing excess body weight and relieving the metabolic complications.