肌少症性肥胖对腹腔镜胃袖状切除术短期减重疗效的影响

Effect of sarcopenic obesity on efficacy of laparoscopic sleeve gastrectomy for short-term weight loss

目的探讨肌少症性肥胖(sarcopenicobesity,SO)对腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)减重效果的影响,并研究影响LSG手术后减重成功的危险因素。方法回顾性分析2020年5月至2023年9月在南昌大学第一附属医院行LSG的104例肥胖病人临床资料,其中SO组34例,非肌少症性肥胖(non-sarcopenic obesity,NSO)组70例。根据病人术前第3腰椎CT影像计算脂肪质量与脱脂质量的比值不低于0.8诊断为SO,对比分析SO对LSG减重疗效的影响,并运用单因素及多因素分析发现影响术后减重成功的危险因素。结果与NSO组相比,术前基线资料显示SO组病人术前体重指数、皮下脂肪面积的均值更大,Ⅲ度肥胖病人的占比更高,但是脱脂质量和骨骼肌面积的均值更小,差异均有统计学意义(均P<0.001);术后随访资料显示SO组病人术后体重指数、多余体重指数的均值更大,但多余体重减少百分比的均值和减重疗效率更低,差异均有统计学意义(均P<0.05)。多因素分析发现体重指数和糖尿病是影响LSG术后减重疗效的两个独立危险因素。结论SO对LSG的短期减重效果存在不良的影响,糖尿病和体重指数是影响LSG术后减重成功的两个独立危险因素。

Objective To explore the effect of sarcopenic obesity(SO)on efficacy of laparoscopic sleeve gastrectomy(LSG)for weight reduction and examine the influencing factors for successful postoperative weight reduction.Methods From May 2020 to September 2023,retrospective analysis was performed for the relevant clinical data of 104 obese patients undergoing LSG.They were assigned into two groups of SO(n=34)and non-sarcopenic obesity(NSO,n=70).SO was diagnosed on the basis of preoperative third lumbar spine on computed tomography(CT)with a ratio of fat mass to defatted mass of not less than 0.8.The effects of SO on efficacy of LSG were analyzed comparatively and the risk factors for successful postoperative weight loss examined by unifactorial and multifactorial analyses.Results As compared with NSO patients,preoperative baseline data indicated that mean values of preoperative body mass index(BMI)and subcutaneous fat area were greater in SO patients and there was a greater percentage of patients with degreeⅢobesity.However,mean values of desiccated mass and skeletal muscle area were smaller.And the differences were statistically significant(P<0.001).Postoperative follow-up data showed that mean values of postoperative BMI and excess BMI were greater in SO patients.However,mean values of percent excess weight loss and success rate of weight loss were lower and the differences were statistically significant(P<0.05).Multivariate analyses revealed that BMI and diabetes mellitus were two independent risk factors for successful postoperative weight loss.Conclusion LSG is less effective for weight loss in SO patients.And DM and BMI are two independent risk factors for successful postoperative weight reduction.