腹腔镜袖状胃切除术治疗病态性肥胖症合并2型糖尿病的疗效及相关因素分析

目的:探讨腹腔镜袖状胃切除术(LSG)治疗病态性肥胖症合并2型糖尿病的临床疗效,并分析影响疗效的相关因素。方法:回顾分析2013年7月至2018年7月为45例病态性肥胖症合并2型糖尿病患者行LSG的临床资料及随访情况,分析手术对患者体重及血糖的控制情况,并应用单因素与多因素Logistic回归分析影响体重及血糖控制效果的相关因素。结果:45例手术均顺利完成,术后随访1年,患者体重、空腹血糖呈下降趋势,34例减肥效果佳或良好(额外体重减轻百分率≥50%),28例2型糖尿病治疗明显有效,有效率为62.2%。单因素Logistic回归分析显示,BMI、遵循术后指导及术后胃饥饿素水平影响LSG治疗病态性肥胖症的疗效(P<0.05);额外体重减轻百分率、吸烟、空腹胰岛素、胰岛素抵抗指数、术后胆汁酸水平影响LSG对2型糖尿病的疗效(P<0.05)。多因素回归分析显示,BMI、是否遵循术后指导及术后胃饥饿素水平是LSG对病态性肥胖疗效的独立影响因素(P<0.05);额外体重减轻百分率、吸烟及胰岛素抵抗指数是LSG对2型糖尿病疗效的独立影响因素(P<0.05)。结论:LSG不仅治疗病态性肥胖症疗效确切,对于合并的2型糖尿病也有明显缓解作用,值得推广应用。     

腹腔镜袖状胃切除术治疗阻塞性睡眠呼吸暂停 综合征的短期疗效观察

目的:探讨腹腔镜袖状胃切除术(LSG)治疗阻塞性睡眠呼吸暂停综合征(OSAHS)的短期疗效,并探讨其变化的相关因素。方法:回顾分析2017年6月至2017年12月为13例肥胖症合并OSAHS患者行LSG的临床资料,分别于术前、术后4～5 d行多导睡眠监测,观察手术前后呼吸暂停低通气指数(AHI)及体重指数(BMI)的变化。结果:术后BMI[(44.25±9.20)kg/m~2 vs.(45.95±9.48)kg/m~2,P0.001]、AHI[(32.56±24.22)次/h vs.(45.58±32.30)次/h,P=0.036]较术前下降;术后BMI变化与术后AHI变化无明显相关性(r=0.318,P=0.290),年龄(r=0.159,P=0.603)、性别(t=0.502,P=0.626)、术前BMI(r=0.008,P=0.980)与术后AHI变化无相关性。结论:LSG可在短期内改善OSAHS,且OSAHS的短期缓解不依赖BMI的下降,术前BMI、年龄、性别不是影响AHI变化的因素。     

腹腔镜袖状胃切除术与胃旁路术治疗肥胖症的临床疗效观察

目的:观察腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)及腹腔镜胃转流术(laparoscopic gastric bypass,LGBP)治疗肥胖症及其并发症的可行性与手术疗效。方法:回顾分析2011年1月至2013年12月20例接受LSG治疗及28例接受LGBP治疗的肥胖症患者的临床资料,观察减重效果及其并发症改善情况。结果:48例手术均在腹腔镜下顺利完成,无术中并发症发生及中转开腹。术后随访1年,LSG组与LGBP组的体重指数[LSG:(24.40±1.46)kg/m2,LGBP:(24.50±1.37)kg/m2]均较术前[LSG:(35.44±2.62)kg/m2,LGBP:(34.18±2.36)kg/m2]显著降低(LSG:t=19.654,P=0.000;LGBP:t=16.620,P=0.000)。2组患者高脂血症、高血压、胃食管反流性疾病、阻塞性睡眠呼吸暂停综合征及2型糖尿病等肥胖相关并发症发生率显著降低(P0.05)。结论:LSG与LGBP治疗肥胖症及其并发症是安全、有效、切实可行的。单纯性肥胖症患者宜采用LSG治疗,合并2型糖尿病的肥胖症患者宜采用LGBP治疗。     

减重代谢手术治疗肥胖合并中重度阻塞性睡眠呼吸暂停低通气综合征术后2年疗效分析

目的 初步探讨腹腔镜胃袖状切除术（LSG）和腹腔镜Roux-en-Y 胃旁路术（LRYGB）治疗肥胖合并中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）术后2年疗效。方法 回顾性分析上海交通大学医学院附属第九人民医院普外科2016年1月至2019年6月接受LSG或LRYGB的肥胖合并中重度OSAHS病人116例病例资料。根据不同手术方式分为LSG组（77例）和LRYGB组（39例）。比较两组病人术后2年疗效。结果 LSG组手术时间低于LRYGB组,而两组间术中出血量和术后住院时间差异均无统计学意义。术前与术后2年两组病人呼吸紊乱指数（AHI）值比较,分别为：LSG组［（64.2±21.6 ）次/h vs. （13.6 ± 4.1）次/h］和LRYGB组［（59.8±10.5）次/h vs.（12.5±2.4）次/h］,差异有统计学意义（P＜0.001）。两组术后平均血氧饱和度（SaO2）和最低SaO2相较于术前均升高（P＜0.001）。而两组间术后2年OSAHS相关各指标（AHI、 平均SaO2、最低 SaO2）比较差异均无统计学意义（ P均＞0.05）。减重手术治疗OSAHS的临床有效率为100.0%;LSG组的治愈率和显著有效率分别为15.6%和62.3%,LRYGB组的治愈率和显著有效率为15.3%和58.9%;两组间治愈率和显著有效率差异无统计学意义。两组病人术后2年肥胖各指标（体重、BMI、%TWL、颈围、腰围、胸围）均较术前降低（P＜0.001）,而两组间术后2年肥胖各指标比较差异无统计学意义（P＞0.05）。OSAHS病情改善情况与术后颈围下降具有相关性(LSG组：r=0.521,P =0.021;LRYGB组：r=0.4950,P =0.044）。结论 LSG和LRYGB能够有效地治疗肥胖合并中重度OSAHS,OSAHS的残余问题需进一步密切随访和开展多学科协助诊治。     

减重代谢手术治疗肥胖合并重度阻塞性睡眠呼吸暂停短期疗效分析

目的分析和比较腹腔镜胃袖状切除术(LSG)和腹腔镜胃旁路手术(LRYGB)对肥胖合并重度阻塞性睡眠呼吸暂停(OSA)病人的短期治疗效果。方法回顾性分析上海交通大学医学院附属第九人民医院普外科2016年1月至2017年1月收治的52例肥胖合并重度OSA并接受减重代谢手术病人的临床资料,按手术方式分为LSG组(32例)和LRYGB(20例),评估手术风险以及手术对体重、OSA病情的影响。结果术后短期随访6个月,两组病人均无严重并发症发生。LSG组与LRYGB组两组手术时间、术中失血量和住院时间差异有统计学意义(P0.01)术后两组肥胖和OSA病情均有缓解,其中LSG组术后6个月呼吸暂停低通气指数(AHI)与术前AHI差异有统计学意义[(25.9±7.8)次/h vs.(69.7±11.4)次/h,P0.05];LRYGB组术后AHI与术前AHI相比差异有统计学意义[(24.9±6.7)次/h vs.(66.8±10.5)次/h,P0.05],而两组间差异无统计学意义(P0.05)。术前AHI可能是影响减重手术治疗肥胖合并OSA疗效的独立影响因素。结论 LSG和LRYGB均可以有效治疗肥胖合并重度OSA的病情,短期疗效明显,长期效果仍待观察研究。     

腹腔镜下袖状胃切除术89例回顾性分析

目的总结腹腔镜下袖状胃切除术的临床应用要点。方法回顾性分析2010年7月至2012年6月上海第二军医大学长海医院普一科89例行腹腔镜下袖状胃切除术的临床资料,手术由同组医师完成,随访时间1～23个月。结果全部手术均经腹腔镜完成手术,无中转开腹,无术中并发症发生,平均手术时间(119.5±16.8)min,平均术中出血量(152.6±51.7)ml。术后患者额外体重减轻百分率(EWL%)呈上升趋势,术后1周、1个月、3个月、6个月额外体重减轻百分率平均分别为11.68%、32.33%、55.83%、74.55%。结论腹腔镜下袖状胃切除术是安全有效的手术,合理选择手术适应证及规范化手术操作及术后管理可以获得良好的临床效果。     

腹腔镜袖状胃切除联合食管裂孔疝修补术治疗肥胖合并阻塞性睡眠呼吸暂停综合征的近期疗效

目的:探讨腹腔镜袖状胃切除(LSG)联合食管裂孔疝修补术(HHR)治疗肥胖合并阻塞性睡眠呼吸暂停综合征(OSAS)的近期疗效。方法:回顾分析2018年3月至2019年5月接受LSG+HHR治疗的23例肥胖合并OSAS患者的临床资料。其中男11例,女12例,平均(38.13±11.84)岁,体质量指数平均(37.84±4.03)kg/m²;记录术前、术后6个月患者体重、BMI、胃食管反流病调查量表评分、24 h pH检测及呼吸暂停低通气指数、最低血氧饱和度等指标。采用配对t检验比较手术前后临床指标,采用Pearson相关性分析分析数据间的相关性。结果:术后6个月,患者体重由术前的(100.78±9.11)kg降至(80.74±7.74)kg;BMI由术前的(37.84±4.03)kg/m²降至(28.98±2.36)kg/m²;呼吸暂停低通气指数由术前的(34.04±13.8)降至(5.67±3.35);最低血氧饱和度由术前的(72.3±4.19)提至(85.97±5.27),OSAS轻度、中度、重度组胃食管反流病阳性率分别为33.33%(2/6)、37.5%(3/8)与66.67%(6/9),差异有统计学意义(P<0.05),患者体重、酸反流及睡眠呼吸相关指标均明显改善。结论:LSG+HHR治疗肥胖合并OSAS的效果较好,可达到抗反流、减重及改善OSAS等目的。     

腹腔镜袖带胃切除术治疗病态性肥胖合并2型糖尿病的疗效评价

目的评估腹腔镜袖带胃切除术（LSG）治疗病态性肥胖2型糖尿病的疗效。方法2007年1月至7月，对来自全美的30例体质量指数（BMD大于或等于35、且合并2型糖尿病的病态性肥胖志愿患者行LSG，术后所有病例随访6个月。分析患者手术前后血糖控制情况、BMI变化和超重体重下降百分比（EWL％）及血糖指标变化情况和Ghrelin激素。结果本组30例患者在接受LSG后6个月，糖尿病治愈率达63％（19／30），缓解率达37％（11／30），术后6个月总有效率为100％。结论LSG对病态性肥胖2型糖尿病有着良好的短期治疗效果。     

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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。     

肥胖患者腹腔镜胃减容术后早期低氧血症危险因素分析

目的探讨肥胖患者腹腔镜胃减容术(LSG)后早期低氧血症的危险因素。方法回顾性分析2017年1月—2021年12月全身麻醉下行LSG的271例肥胖患者资料, 美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级、体重指数(BMI)≥35 kg/m2、性别不限、年龄18～50岁。根据患者入麻醉后监测治疗室(PACU)30 min是否出现低氧血症, 分为低氧血症组[动脉氧分压/吸入氧浓度(PaO2/FiO2)≤300 mmHg(1 mmHg=0.133 kPa), 93例]和非低氧血症组(PaO2/FiO2>300 mmHg, 178例)。单因素分析两组患者一般情况、术前吸烟史及合并基础病史、术前检查、手术和麻醉相关因素, 将两组差异有统计学意义的因素纳入多因素logistic回归分析, 分析肥胖患者LSG后早期低氧血症的危险因素。结果纳入患者术后早期低氧血症发生率为34.7%。与非低氧血症组比较, 低氧血症组男性占比、体重、BMI、有阻塞性睡眠呼吸暂停低通气综合征(OSAHS)病史比例、术中舒芬太尼用量等较高(均P<0.05), 手术时间较长(P<0.05), 术前第1秒用力呼气量(F...     

Does Gastric Dilatation Limit the Success of Sleeve Gastrectomy as a Sole Operation for Morbid Obesity?

Background: Sleeve gastrectomy as the sole bariatric operation has been reported for high-risk super-obese patients or as first-step followed by Roux-en-Y gastric bypass (RYGBP) or duodenal switch (DS) in super-super obese patients. The efficacy of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of <50 kg/m² and the incidence of gastric dilatation following LSG have not yet been investigated. Methods: 23 patients (15 morbidly obese, 8 super-obese) were studied prospectively for weight loss following LSG. The incidence of sleeve dilatation was assessed by upper GI contrast studies in patients with a follow-up of >12 months. Results: Patients who underwent LSG achieved a mean excess weight loss (EWL) at 6 and 12 months postoperatively of 46% and 56%, respectively. No significant differences were observed in %EWL comparing obese and super-obese patients. At a mean follow-up of 20 months, dilatation of the gastric sleeve was found in 1 patient and weight regain after initial successful weight loss in 3 of the 23 patients. Conclusion: LSG has been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was found in only 1 patient in this short-term follow-up. Weight regain following LSG may require conversion to RYGBP or DS. Follow-up will be necessary to evaluate long-term results.     

腹腔镜袖状胃切除术治疗重度肥胖症的临床疗效

目的探讨腹腔镜下袖状胃切除术对重度肥胖症(体重指数BMI>35)的临床疗效。方法 2008年8月～2011年5月,对30例重度肥胖症患者实施腹腔镜袖状胃切除术,全身麻醉,腹腔镜下超声刀离断胃周韧带,术中电子胃镜指引下,使用Endo-GIA紧贴胃大弯侧行袖状胃切除。术后随访1年,观察BMI及超重体重下降百分比(excess weight loss,EWL%)的变化情况。结果 30例手术顺利,无术中并发症及中转开腹。术后1年体重指数(28.7±5.3)较术前(35.2±7.2)降低(t=3.98,P<0.001)。术后1年随访EWL%,根据Reinhold等制定的标准,效果极佳24例(80%)(EWL%76%～90%),良好6例(20%)(EWL%55%～73%)。结论腹腔镜袖状胃切除术治疗重度肥胖症近期疗效明显,长期疗效有待进一步观察。     

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...     

A Meta-analysis of 2-Year Effect After Surgery: Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity and Diabetes Mellitus

Literature search was performed for bariatric surgery from inception to September 2013, in which the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on body mass index (BMI), percentage of excess weight loss (EWL%), and diabetes mellitus (DM) were compared 2 years post-surgery. A total of 9,756 cases of bariatric surgery from 16 studies were analyzed. Patients receiving LRYGB had significantly lower BMI and higher EWL% compared with those receiving LSG (BMI mean difference (MD)?=??1.38, 95 % confidence interval (CI)?=??1.72 to ?1.03; EWL% MD?=?5.06, 95 % CI?=?0.24 to 9.89). Improvement rate of DM was of no difference between the two types of bariatric surgeries (RR?=?1.05, 95 % CI?=?0.90 to 1.23). LRYGB had better long-term effect on body weight, while both LRYGB and LSG showed similar effects on DM.     

腹腔镜袖状胃切除术的围手术期处理

目的总结腹腔镜袖状胃切除术（LSG）治疗病态性肥胖症患者的疗效及其围手术期处理方法。方法回顾性分析2010年5月至2012年12月在第二军医大学长海医院行LsG手术、并获得至少1年术后随访的57例病态性肥胖症患者的临床资料。所有患者均予以充分的术前准备和严格的术后管理．并通过随访了解其术后额外体质量减轻百分率（EWL％）和术前合并症的缓解情况。结果除1例因腹腔广泛粘连中转开腹,其余56例患者均在腹腔镜下完成手术。手术时间（102．0±15．2）min,术中出血（132．3±45．6）ml。无围手术期死亡患者,无吻合口瘘、吻合口狭窄及切口感染发生。术后出血2例。其中1例经输血和止血药等保守治疗止血,另1例行再次腹腔镜探查止血。全组患者术后3、6和12月,EWL％分别为（54．9±13．8）％、（79．0±23．6）％和（106．9±25．1）％,且术前合并症均获得了不同程度的缓解或改善。结论LSG对肥胖症有良好的临床治疗效果,通过加强围手术期管理．可以提高手术安全性和术后疗效。     

Early-phase insulin hypersecretion associated with weight loss outcome after LSG: a prospective cohort study in Asian patients with BMI ≥28 kg/m2

BackgroundObesity has become a global problem that poses a serious threat to human health. Laparoscopic sleeve gastrectomy (LSG) is an effective long-term treatment. However, the weight loss of some patients after LSG is still insufficient. It is necessary to investigate the factors associated with inadequate weight loss after LSG.ObjectiveThe objective of this study was to explore whether preoperative insulin secretion could be associated with weight loss after LSG in patients with obesity.SettingThis is a single-center prospective cohort study conducted in a university hospital.MethodsPatients from a prospective database who underwent LSG were analyzed. All 178 participants underwent a 75-g oral glucose tolerance test (OGTT) to assess preoperative insulin and c-peptide secretion before LSG. The areas under the curve (AUCs) for glucose, insulin, and c-peptide were determined in the OGTT. The percentage of excess weight loss (%EWL) and the percentage of total weight loss (%TWL) were used to estimate the effect of weight loss after LSG. Regression models were used to assess the correlation between preoperative insulin and c-peptide secretion with %EWL ≥75% and TWL ≥35% at 12 months after LSG.ResultsThe AUCs of insulin and c-peptide were significantly lower in the %EWL ≥75% and %TWL ≥35% groups at 0–30 minutes, 0–60 minutes, and 0–120 minutes during the OGTT. At 30, 60, and 120 minutes during the OGTT, c-peptide levels were significantly lower in the %EWL ≥75% group and %TWL ≥35% group. The preoperative c-peptide level at 30 minutes during the OGTT (C₃₀) was significantly negatively correlated with %EWL (β = ?.37, P < .001) and %TWL (β = ?.28, P = .011). Univariate logistic regression analysis showed that preoperative C₃₀ was associated with %EWL ≥75% and %TWL ≥35% after LSG. According to multiple logistic regression analysis, patients with a low preoperative C₃₀ had an 8-fold higher %TWL ≥35% after LSG than those with a high C₃₀ (odds ratio: 8.41 [95% confidence interval: 1.46–48.58], P = .017). Similarly, patients with a low preoperative C₃₀ had a 7-fold higher EWL% ≥75% after LSG than patients with a high C₃₀ (odds ratio: 7.25 [95% confidence interval: 1.11–47.50], P = .039).ConclusionsThe rate of weight loss after LSG is low among patients with preoperative hyperinsulinemia. The preoperative c-peptide level at 30 minutes during the OGTT is associated with weight loss after LSG.     

Approach to Poor Weight Loss After Laparoscopic Sleeve Gastrectomy: Re-sleeve Vs. Gastric Bypass

Background

Laparoscopic sleeve gastrectomy (LSG) is increasing worldwide; however, long-term follow-up results included insufficient weight loss and weight regain. This study aims at assessing the outcomes of converting LSG to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic re-sleeve gastrectomy (LRSG).

Methods

A total of 1300 patients underwent LSG from 2009 to 2012, of which 12 patients underwent LRYGB and 24 patients underwent LRSG in Al-Amiri Hospital alone. Data included length of stay, percentage excessive weight loss (EWL%), and body mass index (BMI).

Results

Twenty-four patients underwent conversion from LSG to LRSG, and 12 patients underwent conversion from LSG to LRYGB due to insufficient weight loss and weight regain. Eighty-five percent were females. The mean weight and BMI prior to LSG for the LRYGB and LRSG patients were 136.5 kg and 52, and 134 kg and 50, respectively. The EWL% after the initial LSG was 37.9 and 43 %, for LRYGB and LRSG, respectively. There were no complications recorded. Results of conversion of LSG to LRYGB involved a mean EWL% 61.3 % after 1 year (p value 0.009). Results of LRSG involved a mean EWL% of 57 % over interval of 1 year (p value 0.05). Comparison of the EWL% of LRYGB and LRSG for failed primary LSG was not significant (p value 0.097).

Conclusion

Following our algorithm, revising an LSG with an LRSG or LRYGB for poor weight loss is feasible with good outcomes. Larger and longer follow-up studies are needed to verify our results.