减重代谢手术前后规范化胃镜检查的分析研究

目的从消化内镜医生角度来分析减重手术前后消化道腔内的特征及远期随诊。 方法回顾性分析2020年6月1日至2021年11月30日经首都医科大学附属复兴医院减重患者132例,对比手术前后7 620张胃镜图片。 结果减重手术前的胃镜检查显示,52例(39.4%)发现存在滑动型食管裂孔疝、27例(20.4%)存在反流性食管炎、19例(14.4%)存在胃体黏膜网格样充血水肿、胃窦黏膜颗粒样改变、十二指肠肠绒毛短缩。减重手术后胃镜检查显示,溃疡病腹腔镜袖状胃切除术(LSG)后发生率约2.9%(1例)、腹腔镜Roux-en-Y胃旁路术(LRGB)后发生率约5.3%(1例);均未发生吻合口炎。 结论对减重手术1年后的胃镜检查随访未发现消化道息肉及肿瘤倾向,针对肥胖症的治疗及防控多学科协作任重道远。     

过去10年我国减重代谢手术的研究进展

目的利用计量分析的方法对我国过去10年发表的减重代谢手术相关的中文临床型文献进行回顾性分析，归纳分析我国减重代谢手术研究进展。 方法以检索词（"减重手术""代谢手术""袖状胃切除""胃旁路术"和"胃绑带术"）检索万方和中国知网数据库在2009年1月1日到2018年12月31日所收录的减重代谢手术相关研究文献，通过对引文中每年发表论文数量，发表论文最多的作者、机构及相关杂志，论文被引次数等相关指标进行整理及分析。 结果总共有1222篇减重代谢手术相关引文被检索到。减重代谢手术相关论文的年发表量呈现先增长后稳定的趋势，从2009年年发表量34篇，在2015年增至175篇，此后呈现相对稳定。朱江帆、王存川、郑成竹等学者在减重代谢手术相关领域发表相关论文最多，暨南大学附属第一医院、第二军医大学附属长海医院、南京医科大学第一附属医院等机构在减重代谢领域处于国内领先水平。中华肥胖与代谢病电子杂志、腹腔镜外科杂志、中国实用外科杂志是目前发表减重代谢手术最多的期刊。 结论我国目前的减重代谢手术基本成熟，但尚需多中心前瞻性临床试验进一步证实减重代谢手术治疗2型糖尿病的有效性。     

腹腔镜Roux-en-Y胃旁路术在治疗非肥胖型2型糖尿病中的应用价值

目的探讨腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)在治疗非肥胖型2型糖尿病中的应用价值,和分析影响手术疗效的临床指标。方法回顾性分析2011年6月至2014年6月在丽水市人民医院胃肠外科接受LRYGB治疗的32例非肥胖型2型糖尿病患者的临床资料。所有患者均签署知情同意书,符合医学伦理学规定。根据手术后降糖疗效的差异将患者分为完全缓解组、部分缓解组和无效组。其中完全缓解组12例,男6例,女6例;平均年龄(50±10)岁。部分缓解组19例,男9例,女10例;平均年龄(51±7)岁。无效组1例,男性,64岁。记录所有患者术前和术后3、6、12个月的腰围、体重、体质指数(body mass index,BMI)、空腹血糖(fasting plasma glucose,FPG)、餐后2小时血糖(2-hour postprandial blood glucose,2h PG)、糖化血红蛋白、C肽、胰岛素、甘油三酯、总胆固醇、胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)和胰岛素分泌功能指数(homeostatic model assessment ofβ-cell function,HOMA-β)。所有患者手术前后、完全缓解组和部分缓解组临床指标的比较采用t检验。结果术后12个月,12例患者的2型糖尿病获得完全缓解,19例患者的2型糖尿病获得部分缓解,总治疗有效率为96.9%。完全缓解组患者术前的病程和腰围分别为(5±3)年和(87±7)cm,明显短于部分缓解组的(8±4)年和(92±8)cm(t=2.54、2.23,P<0.05);完全缓解组患者术前的FPG和2h PG分别为(7.0±1.6)mmol/L和(11.9±3.8)mmol/L,明显低于部分缓解组的(11.4±3.3)mmol/L和(19.0±5.7)mmol/L(t=4.96、3.82,P<0.05);完全缓解组患者术前的餐后2小时C肽(2-hour postprandial C-peptide,2h Cp)、餐后2小时胰岛素(2-hour postprandial insulin,2h Ins)和HOMA-β分别为(3.0±1.0)ug/L、(59±42)m U/L和66±22,明显高于部分缓解组的(2.4±0.8)ug/L、(26±12)m U/L和35±20(t=2.19、3.27、4.10,P<0.05);完全缓解组患者术前的HOMA-IR为3.6±2.3,明显低于部分缓解组的5.8±2.2(t=2.70,P<0.05)。结论 LRYGB治疗非肥胖型2型糖尿病能获得较为满意的降血糖血脂疗效;其中病程较短、腰围较小、FPG和2h PG较低、2h Cp和2h Ins较高、HOMA-IR较低和HOMA-β较高的患者通常能获得更好的手术疗效,以上8项指标可能成为判断LRYGB治疗非肥胖型2型糖尿病患者手术疗效的预测因子。     

120例2型糖尿病伴肥胖的减重体会

有资料显示：减重10k，血糖可降低20％。本文作者对120例2型DM合并肥胖患者进行减重指导，并对减重前后的体重指数进行自身对照，取得了一定的效果。报告如下：     

减重代谢手术术中不良事件及处理(附视频)

减重代谢手术在全球得到了越来越多的关注,在我国开展的医院和例数也逐年增多。但减重代谢手术面对的患者为良性疾患,患者自身期望较高,再加上肥胖、糖尿病等合并症,手术的风险和并发症也并不少见。本文拟回顾四川大学华西医院在实施减重代谢手术时术中出现的一些典型不良事件,及其处理对策,旨在为广大减重代谢外科医生提供相关手术经验,促进我国减重外科事业更好地健康平安发展。     

减重手术对肥胖相关代谢异常的作用

减重代谢手术减轻体重、改善代谢的长期效果已得到全球专家的广泛认可。临床已观察到减重代谢手术对肥胖相关2型糖尿病、高血压病、多囊卵巢综合征、代谢相关脂肪性肝病、远期心脑血管病等代谢紊乱的显著疗效。但现行指南推荐手术治疗2型糖尿病的BMI切点相对保守;且新的代谢手术方式如单吻合口十二指肠回肠吻合术,也展现出现极佳的减重降糖的临床效果,何种术式最适合肥胖合并2型糖尿病等代谢疾病患者仍无定论,需要更多包含中国人群的高质量临床证据加以验证并付诸临床。文章根据同济大学附属上海第十人民医院内分泌代谢中心基础及临床研究结果和文献综述,对上述减重代谢手术治肥胖相关代谢疾病的若干问题做一探讨。     

腹腔镜下胃旁路手术治疗2型糖尿病26例

目的:总结腹腔镜胃旁路手术治疗2型糖尿病的初步经验.方法:回顾性分析苏州大学附属第一医院2010-05/2010-11开展的腹腔镜下胃旁路手术(LRYGB)治疗2型糖尿病26例的临床资料.患者纳入标准:BMI≥24 kg/m2、糖化血红蛋白(HbAlc)≥7％、空腹血清C肽≥1μg/L,患者对手术有强烈的要求,依从性好...     

A rare case of gastric lipoma with early gastric cancer

An 84-year-old man was admitted to our hospital with a 1-month history of epigastralgia. Upper gastrointestinal endoscopy revealed gastric cancer and a gastric submucosal tumor (SMT) on the greater curvature of the gastric body. By endoscopic ultrasonography, SMT was demonstrated as a well-circumscribed, smooth-bordered and hypoechoic mass localized in the submucosal layer. Total gastrectomy was performed. The histology of the resected specimen revealed a gastric lipoma and an early gastric cancer widespread to the surface on the lipoma. Two lesions were present in the same lesion, but not linked. We report a rare case of gastric lipoma complicated with early gastric cancer.     

Medical strategies for weight loss in the overweight and obese patient

In recent years, obesity has become a major public health problem in Western countries. The World Health Organization has defined obesity as a global epidemic of the third millennium. Treatment options for weight management include dietary intervention, physical activity, behavior modification, pharmacotherapy and surgery. However, the complexity of this chronic condition necessitates a coordinated multidisciplinary team-approach to the care of obese patients who fail weight control. The long-term duration of the treatment and the necessity of monitoring compliance and effectiveness should be considered. The objective of this article was to review the major controlled randomized clinical trials dealing with the different medical strategies for weight loss and its maintenance in overweight and obese patients.     

Impact of weight loss on cortisol secretion in obese men with and without metabolic syndrome features

BACKGROUND AND AIM: Disturbances in cortisol metabolism have been associated with obesity and metabolic syndrome development. The aim of this study was to evaluate the effect of weight loss induced by an energy-restricted diet on postprandial cortisol secretion in obese men with and without metabolic syndrome features. METHODS AND RESULTS: Twelve obese men (BMI: 32.5-36.2 kg/m2), six without and six with at least three markers of metabolic syndrome, and six lean men (BMI: 22.2-24.9 kg/m2) participated. Plasma cortisol was measured at fasting and at 30 min intervals for 3h after standard breakfast intake. Obese volunteers repeated those measurements after weight loss induced by a 10-week hypocaloric balanced diet. Fasting (p = 0.002) and postprandial (p = 0.014) cortisol secretions in obese men were statistically lower than in lean subjects. The slimming program produced a -0.9 kg per week mean weight reduction with no differences between both groups (p = 0.297). After weight loss, postprandial cortisol secretion increased in volunteers with (p = 0.028) and without metabolic syndrome manifestations (p = 0.043), as compared to baseline, achieving values near to those of controls. Cortisol levels negatively correlated with body weight (r = -0.61; p < 0.001). CONCLUSIONS: Therefore, the effect of weight loss on cortisol metabolism appeared to be mediated by changes in body weight, which were apparently not affected by the occurrence of metabolic syndrome features.     

内镜下表现为浅表病变的进展期胃癌1例

2003年巴黎浅表肿瘤共识对食管、胃、结肠浅表型肿瘤的形态学分型进行了统一，所有浅表型肿瘤均归为O型，无论其病理学结果如何。胃浅表型肿瘤病变包括上皮内瘤变与胃恶性肿瘤，后者绝大多数情况下均指早期胃癌，此外亦包括少数特殊进展期胃癌。以下报告1例浅表型进展期胃癌患者。     

IBL-like T cell lymphoma associated with early gastric cancer: a case report

A 67-year-old man was admitted in October 1987 with complaints of nausea, headache, dizziness and speech disturbance. Hematological examination showed pancytopenia. Bone marrow aspiration failed with a dry tap. A month later, the second aspiration showed hypocellular marrow containing 18.2% of lymphoma cells. Physical examination showed splenomegaly and lymph node swelling. Polyclonal hypergammaglobulinemia was not observed. A lymph node biopsy exhibited typical histology of immunoblastic lymphadenopathy (IBL)-like T cell lymphoma. Surface marker CD3 and CD4 positive cells were dominant. The patient complained of epigastric pain and occult blood was positive in stool. Gastrofiberscopic examination disclosed well differentiated adenocarcinoma in situ located on a polyp, and polypectomy was performed. Lymphoma was treated with cyclophosphamide, doxorubicin, vinblastine and prednisolone. Splenomegaly and lymph node swelling were reduced in size but the effect was temporary. Thereafter the patient has been treated with cyclophosphamide, doxorubicin, vindesine, prednisolone and etoposide every 3 weeks. This is our first case report of IBL-like T cell lymphoma associated with early gastric cancer.     

Resting metabolic rate in obese children before, during and after weight loss.

Resting metabolic rate (RMR) and body composition were measured by indirect calorimetry and body impedance analysis in 14 obese children before weight loss, during weight reduction for 3 weeks with a conventional hypocaloric diet (730 kcal/3050 kJ) and 12 months after weight loss. The initial weight reduction (5.8 +/- 1.2 kg) resulted in a decrease in RMR and fat free mass (FFM) of 17 +/- 10 per cent (P less than 0.001) and 3.1 +/- 2.3 kg (P less than 0.001), respectively. Prior to weight loss (r2 = 0.89, P less than 0.001) and after 12 months follow up (r2 = 0.88, P less than 0.001) RMR correlated positively with FFM. Changes in RMR after 3 weeks weight loss and throughout the follow-up were positively correlated with changes in FFM (r2 = 0.29, P less than 0.05 and r2 = 0.90, P less than 0.001). Our data indicate that RMR in obese children considerably decreased during a 3 weeks weight reduction, but no sustained depression of the metabolic rate after 12 months was found.     

Changes in sex hormone-binding globulin and testosterone during weight loss and weight maintenance in abdominally obese men with the metabolic syndrome

Background: Mild hypoandrogenism in men, usually defined by low levels of testosterone, is a peculiar feature of abdominal obesity that independently predicts the development of insulin resistance and diabetes mellitus. Little is known about the short‐ and long‐term effects of weight loss on sex steroids in abdominally obese men, however. Objectives: We assessed the effect of rapid weight loss and sustained weight maintenance on the plasma concentrations of testosterone and other sex hormones in 58 abdominally obese men (age, 46.3 ± 7.5 years; body mass index, 36.1 ± 3.8 kg/m²; waist girth, 121 ± 10 cm) with the metabolic syndrome. Results: The men lost on average 16.3 ± 4.5 kg during a 9‐week very low‐calorie diet (VLCD) and maintained 14.3 ± 9.1 kg weight loss after a 12‐month maintenance period (vs. baseline, p < 0.001). Sex hormone‐binding globulin (SHBG) increased from 27.6 ± 11.9 to 48.1 ± 23.5 nmol/l during the VLCD but decreased to 32.6 ± 12.9 nmol/l during weight maintenance, which was still higher than at baseline (p < 0.001). Free testosterone (fT) increased from 185 ± 66 to 208 ± 70 pmol/l (p = 0.002) during the VLCD and remained high after 1 year of weight maintenance (212 ± 84 pmol/l, p = 0.002). Total testosterone levels followed a pattern intermediate between fT and SHBG. Plasma estradiol and dehydroepiandrosterone sulphate concentrations changed only transiently or not at all. Conclusions: Rapid weight loss with successful weight maintenance in abdominally obese men with the metabolic syndrome brings about a sustained increase in fT levels. The dramatic increase in SHBG attenuated initially during weight maintenance but remained elevated. These findings may be important with regard to prevention of progressive metabolic decompensation and cardiovascular disease associated with obesity and the metabolic syndrome.     

Psychological assessment and management of the weight loss surgery patient

Psychological evaluation of the weight loss surgery patient is recommended because of the prevalence of psychiatric comorbidities in persons with severe obesity and the behavioral adaptations required for successful surgical outcomes. Although there is currently no national standard for the specific components of these evaluations, there is general agreement in the literature about the objectives and the kinds of assessment methods that are most useful. This paper summarizes the current literature on psychological evaluation of weight loss surgery patients. Methods of assessment relevant to the major behavioral health characteristics of surgical candidates are reviewed, and results from several studies examining weight loss and quality of life outcomes in relation to pre-surgery psychological characteristics are discussed.     

Ghrelin suppression is associated with weight loss and insulin action following gastric bypass surgery at 12 months in obese adults with type 2 diabetes

Roux‐en‐Y gastric bypass (RYGB) surgery reverses type 2 diabetes mellitus (T2DM) in approximately 80% of patients. Ghrelin regulates glucose homeostasis, but its role in T2DM remission after RYGB surgery is unclear. Nine obese T2DM subjects underwent a mixed meal tolerance test before and at 1 and 12 months after RYGB surgery. Changes in ghrelin, body weight, glucagon‐like polypeptide‐1 (GLP‐1, glucose tolerance and insulin sensitivity (IS) were measured. At 1 month, body weight, glycaemia and IS were improved, while ghrelin concentrations were reduced (p < 0.05). After 12 months, body weight and fasting glucose were reduced (30 and 16%, respectively; p < 0.05) and IS was enhanced (threefold; p < 0.05). Ghrelin suppression improved by 32% at 12 months (p < 0.05), and this was associated with weight loss (r = 0.72, p = 0.03), enhanced IS (r = ?0.78, p = 0.01) and peak postprandial GLP‐1 (r = ?0.73, p = 0.03). These data suggest that postprandial ghrelin suppression may be part of the mechanism that contributes to diabetes remission after RYGB surgery.     

Genetic variants associated with weight loss and metabolic outcomes after bariatric surgery: A systematic review

The extent to which genetic variations contribute to interindividual differences in weight loss and metabolic outcomes after bariatric surgery is unknown. Identifying genetic variants that impact surgery outcomes may contribute to clinical decision making. This review evaluates current evidence addressing the association of genetic variants with weight loss and changes in metabolic parameters after bariatric surgery. A search was conducted using Medline, Embase, Scopus, Web of Science, and Cochrane Library. Fifty-two eligible studies were identified. Single nucleotide polymorphisms (SNPs) at ADIPOQ (rs226729, rs1501299, rs3774261, and rs17300539) showed a positive association with postoperative change in measures of glucose homeostasis and lipid profiles (n = 4), but not with weight loss after surgery (n = 6). SNPs at FTO (rs11075986, rs16952482, rs8050136, rs9939609, rs9930506, and rs16945088) (n = 10) and MC4R (rs11152213, rs476828, rs2229616, rs9947255, rs17773430, rs5282087, and rs17782313) (n = 9) were inconsistently associated with weight loss and metabolic improvement. Four studies examining the UCP2 SNP rs660339 reported associations with postsurgical weight loss. In summary, there is limited evidence supporting a role for specific genetic variants in surgical outcomes after bariatric surgery. Most studies have adopted a candidate gene approach, limiting the scope for discovery, suggesting that the absence of compelling evidence is not evidence of absence.