腹腔镜袖状胃切除术对肥胖患者血清尿酸水平的影响

目的:探讨腹腔镜袖状胃切除术对肥胖患者血清尿酸水平的影响。方法:回顾分析2016年1月至2019年1月接受腹腔镜袖状胃切除术的83例肥胖患者的临床资料。依照血清尿酸水平的高低分为尿酸正常(NUA)组(n=41)与合并高尿酸血症(HUA)组(n=42)。统计分析两组患者术前与术后人体测量学指标、部分生化指标的变化情况。采用Pearson相关分析法分析血清尿酸与上述指标间的相关性。结果:术后1个月、3个月、6个月、12个月,两组患者体重、体质量指数、腰围、臀围、体脂肪含量、内脏脂肪面积、总胆固醇、低密度脂蛋白胆固醇均低于术前。术后6个月、12个月,高密度脂蛋白胆固醇高于术前(P0.05)。两组患者血清尿酸均于术后1个月较术前升高后逐渐下降,NUA组于术后12个月降至(289.6±44.1)μmol/L,HUA组降至(321.7±45.0)μmol/L;通过相关性分析发现,NUA组术后12个月血清尿酸的变化值与Δ体重、Δ体质量指数、Δ总胆固醇、Δ低密度脂蛋白胆固醇呈显著正相关(P0.05);HUA组患者术后12个月血清尿酸的变化值与Δ体重、Δ体脂肪含量呈显著正相关(P0.05)。结论:腹腔镜袖状胃切除术不仅减重效果确切,还能有效降低肥胖患者血清尿酸水平,尤其肥胖合并高尿酸血症的患者疗效明显,这可能与腹腔镜袖状胃切除术降低肥胖患者体重、体脂肪含量相关。     

腹腔镜袖状胃切除术对肥胖合并2型糖尿病患者牙周状况影响的临床研究

目的:探讨腹腔镜袖状胃切除术对肥胖合并2型糖尿病患者牙周状况的影响。方法:分析2019年6月至2020年4月接受腹腔镜袖状胃切除术的肥胖合并2型糖尿病患者的临床资料,选取其中的34例牙周炎患者,男11例,女23例。分别于术前及术后3、6、12个月记录患者身高、体重,检测血糖水平、探诊深度、出血指数、菌斑指数、临床附着丧失,以评估患者牙周状况。结果:术后患者体重呈进行性下降,空腹血糖与糖化血红蛋白于术后3个月有显著改善。牙周健康评估结果显示,术前、术后各随访时点患者的探诊深度、临床附着丧失差异无统计学意义,但术后3、6、12个月的菌斑指数均较术前显著下降,术后6、12个月的出血指数较术前显著下降。结论:腹腔镜袖状胃切除术可在一定程度上改善肥胖合并2型糖尿病患者的牙周炎症。     

腹腔镜袖状胃切除术治疗肥胖及其并发症20例报告

目的:探讨腹腔镜袖状胃切除术治疗肥胖及其并发症的可行性。方法:回顾分析2020年5月至2021年5月接受腹腔镜袖状胃切除术治疗的20例肥胖患者的临床资料，整理术前(性别、年龄、体重、体重指数、糖化血红蛋白、甘油三脂及血压)、术中(出血量、手术时间)、术后(术后胃残端瘘、出血、死亡例数及术后6个月随访时患者的体重、体重指数、糖化血红蛋白、甘油三酯及血压)相关指标，并进行统计学分析。结果:20例患者均成功完成腹腔镜袖状胃切除术，术中出血量平均(25.65±7.04)mL,手术时间平均(63.85±13.81)min;术后2例患者出现消化道出血，无术后胃瘘及围手术期死亡病例。术后6个月随访，患者体重较术前平均下降(22.15±8.37)kg,体重指数平均下降(7.55±2.21)kg/m²,血脂水平均降至正常，7例高血压患者中5例收缩压完全降至正常，另2例血压较术前不同程度降低；2例2型糖尿病患者的糖化血红蛋白较术前均下降。结论:腹腔镜袖状胃切除术治疗肥胖及其相关并发症安全、有效，可作为常规术式在基层医院开展。     

腹腔镜袖状胃切除术的疗效分析

目的:探讨腹腔镜袖状胃切除术治疗肥胖症的临床疗效及其相关并发症。方法:回顾分析2014年4月至2017年1月为28例肥胖症患者行腹腔镜袖状胃切除术的临床资料。术后随访患者体重、体重指数、血糖、糖化血红蛋白、血脂、血红蛋白、维生素B_(12)、叶酸等指标,计算多余体质量下降百分比。结果:28例患者均顺利完成手术,无中转开腹。随访3~36个月,术后患者体重、体重指数明显下降。2例患者减重效果欠佳,多余体质量下降百分比分别为47.2%与42.9%。10例患者合并2型糖尿病,其中8例仅靠生活及饮食可控制空腹血糖;术后血脂及其他相关肥胖并发症均得到明显缓解。2例合并胃食管反流病,术后未见缓解。无营养不良。结论:腹腔镜袖状胃切除术是高效、安全的减重手术,可明显缓解肥胖症患者的体重及相关肥胖并发症。     

腹腔镜袖状胃切除术治疗非酒精性脂肪肝的临床研究

目的:探讨腹腔镜袖状胃切除术治疗肥胖症合并非酒精性脂肪肝的临床效果。方法:回顾分析2013年4月至2017年10月行腹腔镜袖状胃切除术并获完整随访24个月的26例肥胖症合并非酒精性脂肪肝患者的临床资料,分析患者手术前后体重、体重指数、血脂、脂肪肝的变化情况。结果:26例患者均顺利完成腹腔镜手术,术后无严重并发症发生。术后1、3、6、12、24个月随访,随访指标均低于术前,血脂恢复正常,非酒精性脂肪肝明显缓解。结论:腹腔镜袖状胃切除术是治疗肥胖症安全、有效的术式,减重效果确切,同时也是治疗脂肪肝的可靠方法,能显著降低体重与血脂,逆转脂肪肝。     

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目的探讨行腹腔镜袖状胃切除术治疗合并2型糖尿病(type 2 diabetes mellitus,T2DM)肥胖症病人的效果。方法回顾性分析第二军医大学附属长海医院微创外科2010年7月至2011年6月行腹腔镜袖状胃切除术治疗合并T2DM的肥胖症19例病人的术前资料和术后6个月的随访资料。结果均在腹腔镜下完成手术。术后均无严重并发症发生。在术后6个月的随访过程中,病人体重、腰围、体重指数均呈下降趋势,与术前相比,术后1周开始差异即有统计学意义(P<0.01)。病人术后1周、1个月、3个月、6个月额外体重减轻百分率分别为(11.68±4.07)%、(32.33±9.12)%、(55.83±14.11)%、(74.55±20.39)%。术后6个月T2DM临床完全缓解15例(78.9%),临床部分缓解4例(21.1%)。所有病人术后糖化血红蛋白、空腹血糖、胰岛素抵抗指数均呈下降趋势,从术后1个月开始,糖化血红蛋白与术前相比差异有统计学意义(P<0.01),术后3个月复查15例(78.9%)已恢复正常水平;空腹血糖和胰岛素抵抗指数自术后1周开始与术前相比差异即有统计学意义(P<0.01)。病人术后血脂代谢及肥胖相关合并症如高血压病、脂肪肝、关节退行性变、睡眠呼吸暂停综合征等亦有不同程度的改善。结论腹腔镜袖状胃切除术是一种安全、有效的治疗肥胖症合并T2DM的手术方式。     

机体能量代谢变化对腹腔镜袖状胃切除术后体重下降量的影响

目的:探讨机体能量代谢变化对腹腔镜袖状胃切除术后体重下降量的影响。方法:选择67例行腹腔镜袖状胃切除术的肥胖患者作为研究对象,术后6个月将其分为获得理想减重效果组,即多余体重减少百分比(%EWL)≥50%及未获得理想减重效果组(%EWL<50%)。对比分析术前及术后6个月能量代谢与体成分指标。结果:术后6个月,33例获得理想减重效果。相关性分析得出,%EWL与术后静息能量代谢(REE)/体重(BW)、△REE/BW、△去脂体重百分比呈正相关(r=0.473,P<0.001;r=0.372,P=0.002;r=0.493,P=0.003),%EWL与△呼吸商(RQ)、术后RQ呈现负相关(r=-0.613,P<0.001;r=-0.553,P<0.001)。多元逐步Logistic回归分析显示,术后REE/BW、RQ与获得理想减重效果密切相关。结论:术后REE/BW的增加及术后RQ的下降是获得理想减重效果的有效预测因子。     

袖状胃切除手术前后的胃食管反流病

目的:分析腹腔镜袖状胃切除手术前后的胃食管反流病,研究两者之间的关系。方法:2016年1月至2017年3月行袖状胃切除术61例。术前、术后1个月及6个月行GERD Q评分,术前和术后6个月行胃镜检查。结果:本研究所有病人均顺利完成手术,无严重并发症发生。术后1个月时多余体重减轻为42.65%,总体重减轻为11.69%;6个月时多余体重减轻为96.38%,总体重减轻为28.81%。术前存在GERD的病人14例(23%)。按BMI分级,Ⅰ°肥胖GERD的发生率为15.4%,Ⅱ°肥胖19.0%。Ⅲ°肥胖29.6%。术后1个月时35.7%缓解,6个月时64.3%缓解。未缓解的病人GERD Q评分也无明显升高。术后新发GERD在1个月时为59.6%,6个月时为34.0%。结论:腹腔镜袖状胃切除术后会出现新发GERD病人。术前存在GERD的病人不应成为手术的禁忌证。     

腹腔镜袖状胃切除术后远期效果分析

目的:评价腹腔镜袖状胃切除术治疗病态肥胖症的远期临床效果.方法:2005年9月至2009年9月为47例单纯性肥胖症患者施行腹腔镜袖状胃切除术,术后随访2年,观察体重指数变化和超重体重下降百分比.结果:术后患者均随访12个月以上,无严重并发症发生及营养不良,43例患者减重效果理想.结论:腹腔镜袖状胃切除术减重效果显著,远...     

腹腔镜袖状胃切除治疗肥胖合并2型糖尿病的研究

探讨腹腔镜袖状胃切除术治疗肥胖合并2型糖尿病的效果。选取江津区中心医院拟实施手术治疗的90例肥胖合并2型糖尿病患者,采用随机数字表法分为A组和B组各45例,A组采用腹腔镜袖状胃切除术治疗、B组采用腹腔镜下胃旁路术治疗。对比两组手术时间、手术出血量、术后肛门排气时间、进食流质饮食时间;对比两组术前、术后1个月、术后3个月、术后6个月的空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹C肽,手术前及手术后6个月患者的体重指数(BMI)、腰围、额外体重占比(EWL)、血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。A组手术时间短于B组(P0.05);两组手术出血量、术后肛门排气时间、进流质饮食时间差异无统计学意义(P0.05);经重复测量的方差分析,A组和B组在术前、术后1个月、术后3个月、术后6个月的FPG、2hPG、HbA1c、空腹C肽测定值组间比较,差异无统计学意义(P0.05);但是两组患者的FPG、2hPG、HbA1c、空腹C肽在术后1个月、术后3个月、术后6个月均较本组术前呈显著降低趋势(P0.05);手术前、手术后6个月,A组和B组BMI、腰围、EWL值组间比较,差异无统计学意义(P0.05);术后6个月,两组BMI、腰围较本组术前均显著降低(P0.05);手术前、手术后6个月,A组与B组血清TG、TC、HDL-C、LDL-C值组间比较,差异无统计学意义(P0.05);术后6个月,两组血清TG、TC、LDL-C值较本组术前均显著降低(P0.05),HDL-C测定值较本组术前显著升高(P0.05)。腹腔镜袖状胃切除术治疗肥胖合并2型糖尿病的效果与腹腔镜下胃旁路术差异不大,均能够达到较好减重、控制血糖的目的,但是前者手术操作更简单。     

腹腔镜胃袖状切除对多囊卵巢综合征生殖内分泌功能改善的作用

目的：探讨腹腔镜胃袖状切除术改善多囊卵巢综合征（ polycystic ovary syndrome,PCOS）生殖内分泌失调的可行性及临床疗效。方法2012年2月～2014年2月,对11例伴有肥胖的PCOS患者行腹腔镜胃袖状切除术,观察月经周期、生殖内分泌及体重等的变化。结果11例均成功完成腹腔镜胃袖状切除术,10例（10／11）术后3个月内月经恢复正常周期,其中6例（6／6）术前稀发排卵的患者均恢复正常排卵,4例术前高雄激素血症患者术后3个月雄激素水平均恢复到正常范围,4例（4／7）多毛患者术后3～6个月Ferriman-Gallwey多毛评分降至5分以下。术后随访3～24个月,BMI下降4．1～7．6,（5．3±1．5）。结论腹腔镜胃袖状切除术能有效改善肥胖的PCOS患者的临床症状,术后短时间内月经恢复,不排卵、高雄激素血症改善。     

腹腔镜食管裂孔疝修补术并胃底折叠术对患者生存质量的影响

目的:探讨腹腔镜食管裂孔疝修补术并胃底折叠术对患者生存质量的影响。方法:采用消化病生存质量指数(gastrointestinal Lebens qualities index,GLQI)前瞻性地测定29例患者行腹腔镜食管裂孔疝修补术和胃底折叠术前,术后2周、1个月、3个月、6个月的生存质量值,并进行临床分析。结果:术前患者GLQI指数平均(83.62±13.14),明显低于正常人群(121～125分);术后2周平均(86.76±10.16),较术前有所升高,差异无统计学意义(P>0.05),但患者精神、心理较术前改善(P<0.05);术后1个月、3个月平均为(106.83±8.40)及(113.35±8.54),较术前及术后2周明显升高,差异有统计学意义(P<0.05);术后6个月平均(121.45±5.96),接近或达到正常水平。结论:腹腔镜食管裂孔疝修补术和胃底折叠术可提高患者术后生存质量,使其生存质量接近或达到正常人水平。     

腹腔镜袖套状胃切除术治疗肥胖症

目的 探讨腹腔镜袖套状胃切除术治疗肥胖症的有效性及安全性.方法 自2006年12月至2010年4月,40例肥胖症患者接受了腹腔镜袖套状胃切除术,术前平均体质量、体质量指数、超重体质量分别为(104.2±3.3) kg、(36.9±1.0) kg/m2和(37.8±3.0) kg.前瞻性收集和评价实验数据.结果 所有腹腔镜袖套状胃切除术均顺利完成,无中转开腹手术.平均手术时间(80±18) min,无严重并发症发生.术后住院时间(5.5±1.5)d.术后1、3、6、12个月随访,体质量指数分别减少(4.3±1.7) kg/m2、(7.0±1.9) kg/m2、(9.3±3.1)kg/m2和( 10.1±3.8) kg/m2,超重体质量分别减少35.0％±13.5％、57.1％±17.7％、74.2％±27.2％和81.8％±29.4％.结论 腹腔镜袖套状胃切除术治疗体质量指数较小的肥胖患者是有效和安全的,但需要积累更多病例和长期随访观察研究来比较本手术与其他减肥手术的优缺点.     

Laparoscopic single-port sleeve gastrectomy for morbid obesity: preliminary series

BackgroundLaparoscopic sleeve gastrectomy has been recently proposed as a sole bariatric procedure because of the resulting considerable weight loss in morbidly obese patients. Traditionally, laparoscopic sleeve gastrectomy requires 5–6 skin incisions to allow for placement of multiple trocars. With the introduction of single-incision laparoscopic surgery, multiple abdominal procedures have been performed using a sole umbilical incision, with good cosmetic outcomes. The purpose of our study was to evaluate the feasibility and safety of laparoscopic single incision sleeve gastrectomy for morbid obesity.MethodsA total of 8 consecutive patients underwent laparoscopic single-incision sleeve gastrectomy at the Operative Unit of Bariatric Surgery of the University of Rome Tor Vergata from March 2009 to June 2009.ResultsOf the 8 patients, 5 were women and 3 were men, with a mean age of 44.4 years. The mean preoperative body mass index was 56.2 kg/m². The mean operative time was 128 minutes. The mean postoperative stay was 2.4 days. The mean postoperative body mass index was 49.3 kg/m² at a mean follow-up period of 3.6 months. The mean percentage of excess weight loss was 33% for the same period.ConclusionsLaparoscopic single-incision sleeve gastrectomy seems to be safe, technically feasible, and reproducible. A randomized trial comparing single-incision sleeve gastrectomy and conventional sleeve gastrectomy might be needed to evaluate the postoperative results in relation to the development of abdominal wall complications.     

Psoriasis Following Bariatric Surgery: Clinical Evolution and Impact on Quality of Life on 10 patients

Psoriasis is a chronic systemic disease with important skin manifestations, affecting 2 % of the population. It is more frequent and severe in obese patients, and both have been associated with a higher cardiovascular risk. Recent studies suggest that weight loss may improve psoriasis and metabolic comorbidities in obese patients. We reviewed our prospective electronic database for all patients with psoriasis who underwent bariatric surgery between 2008 and 2011. We assessed surgical complications, weight progression, and psoriasis-related outcomes. The Dermatology Life Quality Index was used retrospectively to assess quality of life (QoL) before and after the operation. Ten patients were included; body mass index was 38.8 ± 5.2 kg/m(2). Pre-surgical treatment for psoriasis was topical (50 %) and systemic (40 %). Eight patients underwent laparoscopic Roux-en-Y gastric bypass and two underwent laparoscopic sleeve gastrectomy. At follow-up, the mean percent excess weight loss 1, 6, and 12 months after surgery was 45 %, 80 %, and 88 %, respectively. Comorbidity resolution was 75 % for diabetes mellitus, 100 % for insulin resistance, and 57 % for hypertension. Related to psoriasis, 70 % of the patients stayed in remission 6 months after surgery and three of the four patients who were previously medicated with systemic drugs discontinued medication. The impact of psoriasis on QoL improved from 14.9 ± 6.8 before surgery to 5 ± 6.3 after surgery (p = 0.005). Bariatric surgery for positive metabolic, skin, and quality of life results should be considered as a useful adjuvant therapy for obese patients with psoriasis.     

Preoperative Change in 6-Minute Walk Distance Correlates With Early Weight Loss After Sleeve Gastrectomy

Introduction:

The 6-minute walk test (6MWT) is an objective preoperative measure of functional capacity and response to intervention in patients with heart or lung disease. In bariatric surgery, there has been no reliable preoperative measure predictive of postoperative success. Here we investigated the impact of bariatric surgery on changes in distance traveled in the 6MWT (the 6MWD) and whether preoperative changes in 6MWD correlated with weight change after surgery.

Methods:

This is a retrospective study of consecutive patients in which the 6MWT was performed before and after laparoscopic sleeve gastrectomy for weight loss. 6MWD and total weight were measured. Pearson correlation was used to determine association between variables.

Results:

Of 100 patients who underwent laparoscopic sleeve gastrectomy, 31 patients had a preoperative 6MWT. Thirty patients (97%) were available for follow-up after surgery. Percentage of excess weight loss was 45.7% over an average of 7 months after surgery. There was a weak correlation between the postoperative weight loss and the change in preoperative and postoperative 6MWD (r = 0.28; P = .13). In a subset of patients who demonstrated a change in distance traveled in 2 separate preoperative 6MWD measurements (average 18.5% increase in distance), there was a strong correlation with postoperative weight loss (r = 0.82; P = .02).

Conclusions:

A demonstrated increase in 6MWD before surgery correlates strongly with early postoperative weight loss after laparoscopic sleeve gastrectomy. A multidisciplinary team that includes a physical therapist is useful in preparing bariatric patients for surgery.     

腹腔镜下袖状胃切除术治疗高体重指数2型糖尿病的效果分析

目的探讨腹腔镜袖状胃切除术(LSG)治疗高体重指数2型糖尿病(T2DM)患者的可行性及疗效的稳定性。 方法回顾性分析2010年至2016年间两个医院24例实施LSG的T2DM患者的临床资料,所有数据建立完整的excel表格,采用SPSS 17.0分析。术前术后体重和糖化血红蛋白(HBALc)水平以( ±s)表示,采用t检验;分类数据以频率和百分比表示,采用卡方检验。P<0.05认为差异有统计学意义。 结果24例患者平均基线体重为(117.2±30.2) kg,在术后3个月、6个月、12个月和24个月时显著下降至(100.3±22.1) kg、(91.6±22.4) kg、(81.3±16.5) kg和(80.3±14.3) kg, P<0.001。术前平均基线HbA1c为(8.5±2.2)%,分别在3个月、6个月、12个月和24个月显著降低至(6.4±1.6)%,(5.8±1.1)%, (5.7±0.7)%和(5.3±0.6)% P<0.001。19例接受袖状胃切除术的T2DM患者停止使用胰岛素和口服降糖药,根据血糖控制标准,24例患者24个月缓解率达79.2%。除1例继续使用2种降压药外,其余高血压患者(17例)停止降压药治疗。 结论LSG治疗高体重T2DM患者,方法简单,手术安全,治疗效果确切,值得在临床中普遍推广应用。     

Laparoscopic gastric bypass for morbid obesity decreases bodily pain, improves physical functioning, and mental and general health in women

INTRODUCTION: Surgery is an effective long-term therapeutic option for morbid obese patients. Although bariatric surgery's amelioration of medical ailments is well established, its nonphysical benefits have not been as well documented. METHODS: Women who had undergone laparoscopic gastric bypass between August 2003 and May 2005 were provided with an SF-36 1 month before surgery, as well as 1, 3, 6, 9, 12, 15, and 18 months after surgery. Those women who completed three surveys were included in this study. Scores were summed for each of six areas analyzed: physical function, physical role limitations, emotional role limitations, bodily pain, mental health, and general health. The results of the preoperative and the last postoperative surveys were compared using Wilcoxon's signed-rank test. RESULTS: Of 91 women considered for this study, 40 (44%) completed at least three postoperative surveys. For bodily pain, physical function, physical role limitations, mental health, and general health, median postoperative exceeded median preoperative scores (P < 0.004 for each analysis); for emotional role limitations, the median postoperative score was the same as the median preoperative score. CONCLUSIONS: In women, gastric bypass for morbid obesity decreases bodily pain and physical role limitations, and improves physical functioning as well as mental and general health. The positive impact of laparoscopic gastric bypass is thus validated by the SF-36 questionnaire.     

The effects of sevoflurane and desflurane on the hemodynamics and respiratory functions in laparoscopic sleeve gastrectomy

Study objectivesSleeve gastrectomy has been one of the most commonly performed bariatric surgery methods. The study aimed to compare the effects of 2 most commonly used inhalation anesthetics, sevoflurane and desflurane, on the peroperative hemodynamic alterations and postoperative respiratory functions in morbidly obese patients undergoing sleeve gastrectomy.DesignNonrandomized cohort.SettingsOperating room, postoperative period.PatientsEighty-four morbidly obese patients with a body mass index greater than 40 kg/m² who had scheduled to undergo sleeve gastrectomy operation were prospectively included in the study.InterventionsPatients were divided into 2 groups. The maintenance of inhalation anesthesia was performed by sevoflurane in 1 group (sevoflurane group) and desflurane (desflurane group) in the other group.MeasurementsDemographic features, peroperative hemodynamic alterations, and the results of preoperative and postoperative 24th hour respiratory function tests were recorded.ResultsThere was not any statistically significant difference between groups regarding age, sex, body mass index, anesthesia time, peroperative mean arterial pressure, arterial oxygen saturation, end-tidal carbon dioxide, and preoperative or postoperative forced expiratory volume 1/forced vital capacity ratios.ConclusionWe determined that both desflurane and sevoflurane provide similar intraoperative hemodynamic and early postoperative respiratory functions in morbidly obese patients in laparoscopic sleeve gastrectomy. Both agents can be regarded as alternatives for inhalation anesthetics in maintenance of anesthesia.