胃旁路手术和袖状胃切除手术术后指导方法的异同分析

<正>目前,我国减重代谢手术的开展规模迅速扩大。代谢手术开展规模的快速扩大得益于其优秀的治疗效果。除了标准的手术操作和正确的手术方式选择以外,规范持续的术后随访指导,也是确保手术治疗效果的重要因素。不能依从术后指导的病人,其减重效果和复胖情况与其他病人存在显著差异^[1]。由于减重代谢手术的术式不断更新发展,不同手术的术后并发症情况和注意事项明显不同。目前,     

胃袖状切除加非离断空肠旁路术治疗肥胖症的近期疗效分析：一项前瞻性队列研究

目的分析胃袖状切除加非离断空肠旁路术(SG-uncut JJB)治疗肥胖症的安全性和近期疗效。方法本研究为前瞻性队列研究(NCT04534504), 纳入首都医科大学附属北京朝阳医院普通外科2020年1—12月间收治的肥胖症患者。纳入标准:(1)体质指数>32.5 kg/m2, 合并或不合并2型糖尿病(T2DM);(2)体质指数为27.5～32.5 kg/m2, 合并T2DM且内科降糖效果不满意或合并有至少两种代谢性疾病(高血压、脂肪肝、多囊卵巢综合征、痛风和高脂血症);(3)T2DM病程<15年且空腹C肽水平大于正常值下限的50%;(4)腹围男性≥90 cm, 女性≥85 cm;(5)年龄16～65岁。排除孕妇、患严重神经或精神疾病、长期服用抗抑郁药和免疫抑制剂、合并严重胃食管反流症状以及修正手术者。入组患者根据医生推荐和患者意愿选择手术方式, 分别纳入SG-uncut JJB组或胃袖状切除(SG)组。剔除随访不足1年和随访指标不完整者。主要结局指标是术后1、3、6和12个月的多余体质量减少百分比(%EWL)和总体质量减少百分比(%TWL), 次要结局指标是术后并发症和自...     

胃袖状切除术加空肠-回肠旁路术对肥胖合并糖尿病大鼠体重和代谢调节作用研究

目的 研究胃袖状切除术（SG）加空肠-回肠旁路术（JIB）对大鼠体重及糖代谢的影响及其机制。方法 于2018年9-11月在复旦大学附属浦东医院完成研究。将12只肥胖合并2型糖尿病（ZDF,fa/fa）大鼠随机等分为两组,分别行SG+JIB（SG+JIB组）和SG+假手术（SG+Sham组）。另有5只ZDF（fa/+）大鼠作为正常对照组。检测术前及术后2、4周大鼠的体重、空腹血糖、摄食量、口服糖耐量试验（OGTT）以及血浆胰高血糖素样肽-1（GLP-1）水平的变化。结果 SG+JIB组与SG+Sham组大鼠术前基线差异无统计学意义（P>0.05）。与SG+Sham组相比,SG+JIB组术后2周（17.3 mmol/L vs. 8.7 mmol/L）、4周（21.4 mmol/L vs. 11.9 mmol/L）空腹血糖均显著降低（P<0.0001）,口服糖耐量也明显改善,两组血糖曲线下面积（180 min总和）在术后2周分别为4221和2964（P<0.0001）,术后4周分别为4104和3388（P<0.01）。同时,术后4周时SG+JIB组GLP-1水平显著高于SG+Sham组（64.6 pmol/L vs. 30.5 pmol/L,P<0.001）。SG+JIB组大鼠每日摄食量和体重仅在术后2周较SG+Sham组减少,术后4周两组差异无统计学意义（P>0.05）。结论 SG+JIB手术可进一步增强SG手术的代谢调节作用,然而对于体重并无显著的额外减轻,建议将SG+JIB手术推荐给需要进一步增强代谢调节的病人,而不建议推荐给以额外降低体重为目的的病人。     

腹腔镜胃袖状切除联合单吻合口十二指肠回肠旁路术治疗肥胖症及肥胖相关代谢病17例疗效分析

目的 探讨腹腔镜胃袖状切除联合单吻合口十二指肠回肠旁路术（SADI-S）治疗肥胖症及肥胖相关性代谢病的临床疗效。 方法 回顾性分析2018年10月至2019年8月吉林大学中日联谊医院减重与代谢外科行腹腔镜SADI-S治疗的17例肥胖症及肥胖相关性代谢病病人的临床资料。观察分析手术对体重、BMI、血压、空腹血糖、糖化血红蛋白、血脂及尿酸的影响。结果 17例病人均完成腹腔镜SADI-S,无严重并发症发生,无中转开腹及围术期死亡。病人的体重、BMI、腰围、多余体重百分比在术后3、6个月均显著下降,差异均具有统计学意义（P＜0.05）。术后3、6个月,2型糖尿病完全缓解率分别为71.4%（5/7）、85.7%（6/7）,高血压缓解率分别为0、6.7%（1/15）,高甘油三酯血症完全缓解率分别为36.4%（4/11）、72.7%（8/11）,高胆固醇血症完全缓解率分别为66.7%（4/6）、83.3%（5/6）,高低密度脂蛋白血症完全缓解率分别为42.9%（3/7）、42.9%（3/7）,高尿酸血症完全缓解率分别为38.5%（5/13）、61.5%（8/13）。结论 腹腔镜SADI-S对肥胖症及肥胖相关性代谢病在术后短期具有显著的治疗效果,但长期安全性及有效性有待进一步随访观察。     

胃袖状切除附加改良空回肠旁路术治疗病态性肥胖症(附1例报道)

目的 探讨胃袖状切除附加改良空回肠旁路术的减肥效果及其在临床中的应用价值.方法 分析我院1例行胃袖状切除附加改良空回肠旁路术治疗的病态性肥胖患者的临床资料.结果 术后随访12个月,多余体重减少达70.8%,无胃肠功能紊乱、营养障碍等并发症.结论 胃袖状切除附加改良空回肠旁路术治疗病态性肥胖近期减重效果确切、安全.     

腹腔镜胃袖状切除术治疗肥胖症

<正>外科减重是目前治疗病态性肥胖症最有效的途径。腹腔镜胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGBP)和腹腔镜可调节胃束带术(laparoscopic adjustable gastric banding,LAGB)是目前最常做的     

超级肥胖的手术选择：袖状胃切除术+空肠空肠旁路术?

目的:分析袖状胃切除术(SG)及SG+空肠空肠旁路术(JJB)治疗超级肥胖患者的疗效及安全性,探讨治疗超级肥胖的手术方式。方法:回顾性收集并分析2017年4月至2021年8月收治的27例超级肥胖患者的临床资料及术后1年随访资料,13例行SG(SG组),14例行SG+JJB(SG+JJB组),对比分析两组减重效果、代谢指标改善情况及手术安全性。结果:与术前相比,术后1年时两组患者体重、体重质量指数均降低,差异有统计学意义;SG+JJB组高密度脂蛋白胆固醇水平升高,总胆固醇、糖化血红蛋白水平下降,差异有统计学意义;SG组空腹血糖、糖化血红蛋白水平下降,高密度脂蛋白胆固醇水平升高,差异有统计学意义。两组间在减重及改善代谢指标方面差异无统计学意义。两组高血压、糖尿病治愈率均为100%。SG组手术时间短于SG+JJB组,差异有统计学意义。SG+JJB组出现1例胃漏,两组术后均未出现消化道出血、狭窄、肠梗阻。结论:SG及SG+JJB治疗超级肥胖均是安全、可行的,均能降低超级肥胖患者体重,同时可改善患者糖代谢及脂代谢,两种术式的减重效果及改善代谢性疾病效果相当,SG手术时间更短,可作为超级肥胖患者手...     

腹腔镜下袖状胃切除加十二指肠空肠短路术治疗2型糖尿病患者的个案管理

目的探索个案管理模式应用于腹腔镜下袖状胃切除加十二指肠空肠短路术治疗正常体质量2型糖尿病患者护理的应用效果。方法针对5例行腹腔镜下袖状胃切除加十二指肠空肠短路术的正常体质量2型糖尿病患者,采用个案管理模式,由个案管理师执行全程围术期护理。结果采用个案管理模式进行围术期护理,5例患者均无并发症发生,出院时体质量平均下降2kg,停用降糖药物,术后1个月随访,脱离降糖药物,效果理想。结论个案管理模式为多专科的临床照护系统,完善了全程护理干预体系,更加规范了此类手术的护理。     

袖状胃切除复合手术的应用进展

正减重代谢外科起源于20世纪50年代,经过全世界减重代谢外科医师的不断验证与改进,减重手术现已被认定为治疗肥胖症等代谢性疾病的"金标准"。减重代谢外科在半个多世纪的发展中形成了多种经典手术方式。根据我国2019年最新修订后公布的《中国肥胖及2型糖尿病外科治疗指南》,目前被减重代谢外科广泛应用的术式包括三种:腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)、腹腔镜Rouxen-Y胃旁路术(laparoscopic Roux-en-Y gas-tric bypass,LRYGB)、胆胰转流十二指肠转位术(bil-iopancreatic diversion with duodenal switch,BPD/DS)~([1])。     

腹腔镜胃袖套状切除减肥术(附1例报告)

目的:探讨腹腔镜胃袖套状切除术(laparoscopic sleeve gastrectomy,LSG)的减肥效果、术后并发症及其在临床中的应用。方法:分析2006年12月我院1例病态肥胖患者行腹腔镜胃袖套状切除术的临床资料。结果:该例病态肥胖患者行腹腔镜胃袖套状切除术后减重明显,无头晕、乏力等身体不适,未出现胃肠功能紊乱、营养障碍等并发症。结论:腹腔镜胃袖套状切除术是安全可行的,具有减重效果明显、并发症少等优点,可作为病态肥胖患者的理想手术方式。     

Laparoscopic sleeve gastrectomy for morbid obesity

The epidemic of obesity in the United States is a major public health issue and more than a third of adults are now considered obese (body mass index ≥ 30 kg/m²). Surgery for morbid obesity, bariatric surgery, is the most durable treatment for this disease and about 140,000 cases are performed annually. Laparoscopic sleeve gastrectomy (LSG) has been advocated as the first of a 2-stage procedure for the high-risk, super-obese patient. More recently, LSG has been studied as a single-stage procedure for weight loss in the morbidly obese. LSG has been shown in initial studies to produce excellent excess weight loss comparable with laparoscopic Roux-en-Y gastric bypass in many series with a very low incidence of major complications and death. We describe our technique for LSG.     

Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity

Background The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (>60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38% and 6%, respectively. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such high-risk patients. This study evaluates our initial outcomes with this technique. Methods In this study, patients underwent laparoscopic sleeve gastrectomy (LSG) as a first stage during the period January 2002–February 2004. After achieving significant weight loss and reduction in co-morbidities, these patients then proceeded with the second stage, laparoscopic Roux-en-Y gastric bypass (LRYGBP). Results During this time, 126 patients underwent LSG (53% female). The mean age was 49.5 ± 0.9 years, and the mean BMI was 65.3 ± 0.8 (range 45–91). Operative risk assessment determined that 42% were American Society of Anesthesiologists physical status score (ASA) III and 52% were ASA IV. The mean number of co-morbid conditions per patient was 9.3 ± 0.3 with a median of 10 (range 3–17). There was one distant mortality and the incidence of major complications was 13%. Mean excess weight after LSG at 1 year was 46%. Thirty-six patients with a mean BMI of 49.1 ± 1.3 (excess weight loss, EWL, 38%) had the second-stage LRYGBP. The mean number of co-morbidities in this group was 6.4 ± 0.1 (reduced from 9). The ASA class of the majority of patients had been downstaged at the time of LRYGB. The mean time interval between the first and second stages was 12.6 ± 0.8 months. The mean and median hospital stays were 3 ± 1.7 and 2.5 (range 2–7) days, respectively. There were no deaths, and the incidence of major complications was 8%. Conclusion The staging concept of LSG followed by LRYGBP is a safe and effective surgical approach for high-risk patients seeking bariatric surgery.     

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...     

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.     

Effect of oral ursodeoxycholic acid on cholelithiasis following laparoscopic sleeve gastrectomy for morbid obesity

BackgroundLaparoscopic sleeve gastrectomy (LSG) is a definitive solution for morbid obesity and its related co-morbidities. Cholelithiasis is a postoperative complication of LSG. The use of ursodeoxycholic acid (UDCA) after LSG is a proposed solution to reduce the incidence of cholelithiasis.ObjectiveTo evaluate the effect of UDCA prophylaxis on cholelithiasis following LSG in morbidly obese patients.SettingTwo university hospitals in Egypt, Cairo, and Beni Suef Universities’ hospitals.MethodsThis prospective study was conducted between July 2015 and March 2018 and included 200 patients scheduled for LSG. They were randomly divided into 2 groups. The UDCA group received a postoperative prophylaxis regimen for prevention of cholelithiasis in the form of 250 mg twice daily of UDCA for 6 months. The control group did not receive prophylactic treatment. Abdominal ultrasound was done at 3, 6, 9, and 12 months for all patients to detect cholelithiasis. The primary outcome measure was cholelithiasis.ResultsOnly 6% of the UDCA group developed cholelithiasis compared with 40% in the control group (P < .001). Age, sex, initial body mass index, and excess weight loss at 6 months did not significantly affect cholelithiasis.ConclusionUDCA treatment for 6 months after LSG is effective in the prevention of cholelithiasis.     

Beyond 5 years: a matched cohort of sleeve gastrectomy versus gastric bypass

BackgroundLaparoscopic sleeve gastrectomy (LSG) has demonstrated excellent short-term outcomes. However, existing studies suffer from loss to follow-up, and most long-term data focus on laparoscopic Roux-en-Y gastric bypass (LRYGB). This study compares weight loss in patients ≥5 years from LSG with that in matched patients who underwent LRYGB.ObjectivesThe purpose of this study was to compare long-term weight loss in patients undergoing LRYGB and LSG.SettingUniversity hospital, United States.MethodsWe retrospectively evaluated patients who underwent LSG before August 2012 with follow-up data ≥5 years. LSG patients were matched 1:1 with LRYGB patients by sex, age at surgery, and preoperative body mass index. Univariate and multivariate analyses were performed with weight loss at the longest duration the primary outcome.ResultsOne-hundred and sixty-five patients underwent LSG during the study period. Long-term follow-up data (≥5 years) were available for 85 patients (52%). There were no preoperative differences between those with and without follow-up data. Six LSG patients (7%) were excluded because they underwent reoperation that altered intestinal anatomy. Of the 79 patients remaining, 75 were matched with post-LRYGB patients. The average follow-up period was 6.4 years for LSG patients and 6.5 years for LRYGB patients (P = .08, not significant). Change in body mass index was 6.81 kg/m² for LSG patients and 13.11 kg/m² for LRYGB patients. Percentage of total body weight loss was 15.25% for LSG patients and 28.73% for LRYGB patients. Percentage of excess body weight loss was 37% for LSG patients and 67% for LRYGB patients (P < .0001). Weight loss for LSG patient follow-up in clinic versus outside the clinic was 46% versus 34% (P = .18, not significant).ConclusionsLSG is now the most common bariatric surgery in the United States. Long-term data are needed to confirm that observed short-term favorable outcomes are maintained. Recent studies have produced divergent results. We observed significantly less weight loss at ≥5 years in LSG patients compared with matched LRYGB patients.