可调节胃束带手术治疗代谢综合征的临床研究及机制分析

目的 观察腹腔镜可调节胃束带术治疗肥胖症的临床效果.方法 根据患者的BMI选择32例重度肥胖症患者行腹腔镜可调节胃束带术.结果 32例患者手术均获成功.1例发生并发症,患者术后出现轻度恶心、呕吐症状,经保守治疗治愈.术后随访24个月以上,减肥效果良好,各项指标稳定.结论 应用腹腔镜可调节胃束带术治疗重度肥胖症效果明显,具有安全微创、可调节、可恢复等特点,值得在临床推广应用.     

腹腔镜可调节胃束带术术后2年随访研究(附23例报告)

目的:探讨腹腔镜可调节胃束带术治疗肥胖症术后2年的临床随访效果。方法:观察总结23例腹腔镜可调节性胃束带术患者术后2年体重下降及术后肥胖并发症的变化情况。结果:术后2年患者减重28~102kg,平均减重46kg,体重减轻指数(excess weight loss,EWL)平均64%。20例患者术前肥胖并发症如高脂血症、糖尿病、高血压病等均有明显改善。术后发生并发症2例,经治疗痊愈,无死亡病例。结论:随访研究证实腹腔镜可调节胃束带术是治疗肥胖症的有效方法,对肥胖引起的并发症同样具有明显的治疗作用。     

腹腔镜可调节胃束带术治疗巨型肥胖症(附2例报告)

外科微创减肥手术已经成为治疗肥胖症的热点。腹腔镜可调节胃束带术(laparoscopic adjustable gastric banding,LAGB)于1993年问世于欧洲,经过十多年的发展与改进,技术已经非常成熟。目前,LAGB已经成为国际上治疗肥胖症的主要外科减肥方法之一。在我国,已经有少数医疗单位开展了腹腔镜可调节胃束带术治疗肥胖症,但多数肥胖症患者的体重指数(BMI)介于33~45。对BMI>50的巨型肥胖患者,由于手术难度明显增大,在亚洲也属罕见。2006年,我们成功对2例BMI>50的巨型肥胖症患者施行腹腔镜可调节胃束带术,随访1年减肥效果良好,现报道如下。1临床资料与方法1.1一般资料例1,男33岁,体重242.5kg,身高182cm,BMI73.2;例2,女25岁,体重158kg,身高170cm,BMI54.7。术前血甘油三酯分别为7.32、7.14mmol/L,血糖分别为9.4、11.2mmol/L。腹部超声均提示脂肪肝。均合并膝关节炎、睡眠呼吸暂停综合征。日常进食量为常人的3倍左右,曾多次行节食、运动、药物及针灸等减肥方法,效果不理想。经内分泌科室检查诊断为单纯性肥胖症。1.2治疗方法...     

腹腔镜胃束带取出术15例报告

目的:总结腹腔镜胃束带取出术的手术经验。方法:回顾分析2010年5月至2014年1月为15例患者行腹腔镜下胃束带取出术的临床资料。其中男4例,女11例;25~49岁,平均(37.0±7.12)岁。束带向食管滑动1例,减重失败后患者要求取出束带1例,束带腐蚀胃壁造成胃瘘1例,束带向胃体滑动造成梗阻9例,需要妊娠3例。结果:15例均顺利完成腹腔镜胃束带取出术,无一例中转开放。手术时间30~60 min,平均(45.0±9.23)min。术中、术后无并发症发生。术日晚患者即可下地活动,术后第1天可进流食,术后住院3~5 d,平均(4.0±0.8)d,术后第7天拆线。15例患者均获随访,随访6~24个月,平均(15.0±5.18)个月。患者饮食正常,无腹痛、腹胀等不适。结论:腹腔镜胃束带术是可逆性手术,腹腔镜胃束带取出术可行、安全。     

172例单纯性肥胖患者行腹腔镜可调节胃束带术后随访结果分析

目的探讨腹腔镜可调节胃束带术治疗单纯性肥胖的减重效果及并发疾病的改善情况。方法对2003年6月至2009年6月间行腹腔镜可调节胃束带术的172例肥胖症患者的随访资料进行总结分析。结果本组患者体质量指数平均38．5kg／m^2,合并糖尿病28例,高血压36例,高血脂85例,呼吸睡眠暂停综合征56例,脂肪肝138例。术后1、3、6、12、24、36和48个月检测体质量指数分别为平均37．2、35．9、34．5、32．9、30．7、29．2和28．1kg／m^2,多余体质量减少率平均分别为10．1％、16．2％、25．1％、37．4％、51．3％、59．0％和62．1％。在术后24、36和48个月时,分别有50．7％、63．6％和70．0％的患者多余体质量减少率大于50．0％。21例（12．2％）术后出现并发症,包括调节泵处感染6例．调节泵翻转2例,调节泵处不愈性溃疡1例,胃小囊扩张7例,胃束带滑脱4例和慢性肠梗阻1例;5例行胃束带取出术。没有围手术期死亡。合并糖尿病者术后17例（60．7％）不服药即可控制血糖：合并高血压者22例（61．1％）血压恢复正常;合并高血脂者49例（57．6％）血脂恢复正常;合并呼吸睡眠暂停综合征患者29例（51．8％）症状消失;所有脂肪肝患者均有不同程度的好转。结论腹腔镜可调节胃束带术能取得良好的减肥效果,并发症较少,肥胖伴发疾病能得到治愈或症状明显改善。     

腹腔镜胃折叠术治疗肥胖症

手术减重是目前治疗病态性肥胖症最有效的治疗手段。腹腔镜Roux—en—Y胃旁路术（1aparoscopicRoux—en—Ygastricbypass,LRYGB）和腹腔镜可调节胃束带术（1aparoscopicadjustablegastricbanding．LAGB）是目前最常做的两种减重手术,腹腔镜袖状胃切除术（1aparoscopicsleevegastrectomy,LSG）是近年来发展比较快的减重术式。近年来越来越多的肥胖症患者接受这些减重手术,     

腹腔镜可调节胃束带术后并发症及治疗

目的探讨腹腔镜可调节胃束带术（LAGB）后并发症及治疗方法。方法回顾性分析2005年9月至2011年6月天津市南开医院行LAGB随访2年以上的83例肥胖症患者的临床资料。腹腔镜下放置胃束带,使束带上方形成1个容量约20～30ml胃小囊,将注水泵埋于剑突下腹直肌前鞘浅面。在术后4周根据患者体质量变化、餐后症状及上消化道造影情况,对胃束带进行注水调节。采用门诊和电话方式进行随访,随访时间截至2013年7月。结果83例患者并发症发生率为44．6％（37／83）,其中早期并发症（1个月内）6例、远期并发症31例。早期并发症主要表现为进食后呕吐,5例患者通过减慢进食速度、减少进食量后缓解;1例患者症状严重,予禁食水并营养支持,5d后症状缓解。远期并发症中,25例患者发生束带腐蚀胃壁并向胃腔内移位（其中6例合并注水泵处感染）,通过腹腔镜手术（早期1例行开腹手术）将胃束带取出,并缝合胃壁穿孔处获得治愈;10例患者发生注水泵相关并发症（6例为上述注水泵感染者,4例为注水泵移位）,通过手术将注水泵取出;2例发生束带滑动移位,通过抽净注水泵内生理盐水,改为流质饮食,减少进食量后,1例患者束带位置恢复正常,另1例患者无变化,行腹腔镜手术取出胃束带。结论LAGB术后并发症发生率较高,并随着术后时间的延长而增高,远期并发症多数需要再次手术治疗。     

腹腔镜可调节胃束带减容术治疗肥胖症的护理体会

目的探讨腹腔镜可调节胃束带减容术（laparoscopic adjustable gastric banding,LAGB）治疗肥胖症的护理体会。方法回顾性分析2007年10月-2009年8月我院3例腹腔镜可调节胃束带减容术的临床护理资料。结果 3例手术均顺利进行,手术时间75 min、100 min、170min,出血量20 ml、30 ml、70 ml,术后住院3 d、4 d、8 d,1例出现套孔管感染,全组无死亡病例。术后随访,根据需要调节捆扎带、控制减重速度,1例随访7月,体重减轻36 kg,1例随访14月,体重减轻40 kg,1例随访22月,减重减轻60 kg,无体重反弹及营养不良病例。结论通过术前良好的心理护理、术前准备及术后并发症的观察与护理,对提高LAGB质量肥胖症的疗效是非常重要的。     

腹腔镜下可调节胃束带术与胃袖状切除术治疗病态肥胖症及其相关并发症的近期临床疗效对比分析

目的探讨腹腔镜下可调节胃束带术(laparoscopic adjustable gastric banding,LAGB)与胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)治疗病态肥胖症及其相关并发症的近期临床疗效及安全性。方法回顾性分析我院在2008年1月~2012年12月收住并行减重手术治疗的83例患者的临床资料,其中行LAGB48例,行L5G35例,观察患者手术前后肥胖相关指标及并发症的变化情况。结果 83例患者均经腹腔镜顺利完成手术,术后随访3~24个月,LAGB术后近期(1个月内)发生进食后呕吐4例,远期(1个月以上)胃束带滑动移位5例,切口脂肪液化1例;LSG术后切口脂肪液化2例。两组患者术后均未出现营养不良、电解质紊乱等严重并发症。术后体质指数、体质量、腰围等指标均呈下降趋势,多余体质量减少百分比(EWL%)呈上升趋势。两组之间上述指标变化趋势及并发症改善比较,LSG优于LAGB,差异有统计学意义(P0.05)。结论两种减重手术方式对治疗病态性肥胖症及其相关并发症都是安全有效的,LSG具有更好的临床疗效。     

减重手术临床并发症的分析

目的:探讨减重手术的并发症及其处理方法。方法:回顾分析31例糖尿病及单纯性肥胖症患者行腹腔镜胃旁路术、胃束带、袖状胃切除、改良胃转流术(袖状胃手术基础上,再行远端空肠与十二指肠球部吻合)的临床资料,总结其并发症情况。结果:本组中,2型糖尿病21例,其中发生左侧胸腔积液1例,吻合口狭窄1例,吻合口溃疡3例,营养不良4例,腹腔内疝1例,粘连性肠梗阻1例,术后胃功能性排空障碍2例。单纯性肥胖症10例,发生减重效果不明显1例,胃小囊及食管扩张1例,注水泵皮下脂肪液化1例,取出胃束带1例。结论:初期开展腹腔镜减重手术难免出现一些并发症,术者应完善术前检查,术中仔细操作以减少不必要的损伤,术后积极采取措施治疗,有的并发症是可以避免的。     

Is it necessary to deflate the adjustable gastric band for subsequent operations?

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is an effective method in the treatment of morbid obesity. However, it is unknown, whether deflating the gastric band before operations under general anesthesia is necessary to avoid complications such as nausea, vomiting, respiratory complications, and weight regain. METHODS: Between January 1996 and June 2001, we performed LAGB on 408 patients at the University Hospital of Innsbruck. Of these patients, we identified 68 (16.7%) patients who were to undergo subsequent unrelated general, reconstructive, vascular, or orthopedic procedures. These patients were prospectively randomized into two groups: group 1 (n = 32) preoperative deflation of the adjustable band system and group 2 (n = 36) without preoperative deflation of the adjustable band system. RESULTS: There were no anesthetic or perioperative band-related complications in either group 1 or group 2. There were two reoperations necessary due to surgical complications unrelated to the gastric band. CONCLUSIONS: Operations after adjustable gastric banding can be safely performed without deflating the adjustable system.     

腹腔镜可调节捆扎带胃减容术操作要点

目的探讨腹腔镜下可调节捆扎带胃减容术的安全性、可行性、有效性。方法对122例单纯性肥胖患者施行腹腔镜可调节捆扎带胃减容术（LAGB），年龄16～62岁，体重指数（BMI）32～52不等的资料进行分析。结果全组无死亡病例，并发症3例，胃排空障碍1例，经保守治疗后好转；皮下注水泵移位2例，经再次手术固定后未再移位。术后随访2～54月，减重10～70kg，平均25kg，无体重反弹及营养不良病例。结论LAGB术操作简便、手术风险小、不对胃进行任何破坏，生理改变较小，且可在体外经胃捆扎带通过水囊进行按需调节调节减重、减重效果持久而明显的优点。     

腹腔镜可调控性胃捆扎带减肥术治疗病态肥胖术后并发症的诊治

目的探讨腹腔镜可调控性胃捆扎带减肥术（LAGB）术后并发症的发生及其诊治。方法回顾分析2003年6月至2004年11月23例在我院行LAGB减肥术的病态肥胖患者的临床资料。结果术后出现恶心、呕吐3例,腹部穿刺口感染1例,进食不耐受5例,以上均经保守处理治愈。捆扎带移位1例,行腹腔镜胃捆扎带取出术。注水泵移位1例,行注水泵异位包埋治愈。未出现死亡和血栓栓塞病例。结论LAGB治疗病态肥胖症的术后并发症的诊断和治疗有其特殊性,只要方法得当,可获得良好效果。     

Early results of recently introduced laparoscopic adjustable gastric banding procedure for morbid obesity in Croatia.

INTRODUCTION: Morbid obesity is a growing medical problem that has become of epidemic proportions. Various dietary and pharmaceutical approaches do not obtain acceptable long-term results. Surgery, however, especially gastric restriction, represents a viable therapeutic solution. Individuals with a body mass index (BMI) >40 kg/m2 or >35 kg/m2 with at least one severe comorbidity are considered morbidly obese and generally qualify for weightloss surgery. Laparoscopic adjustable gastric banding (LAGB) is currently the most commonly performed procedure, because it is minimally invasive, does not cause metabolic complications, is completely reversible, and is adjustable. In Croatia, the first LAGB was performed in May 2004 at Clinical Hospital "Sestre Milosrdnice." The aim of this report is to illustrate a newly performed surgical treatment and its results for morbid obesity in Croatia. METHODS: Within a 12-month period, the adjustable gastric band was implanted in 15 morbidly obese patients (female, 8; male, 7; mean age, 46.67 years; range, 26-59 years). The so-called "pars flaccida" technique was used. RESULTS: One operation required conversion to laparotomy due to a gastric lesion, and 1 laparoscopy operation was terminated due to massive postoperative adhesions. The average duration of surgery was 90+/-30 minutes. Mean length of stay was 4.9 days (range, 3-9). An average BMI at the time of surgery was 52.21 kg/m2 (range, 45.29 to 61.59; mean body weight was 155.58 kg (range, 127 to 204). Throughout 1-, 3-, 6-, 9-, and 12-month follow-ups, an average of 18.71%, 25.06%, 34.37%, 41.23%, and 47.32% of excessive weight loss (EWL) was observed. Good tolerance and a low complication rate were noted. CONCLUSION: LAGB resulted in good early results and a low complication rate. LAGB appears to be a quality surgical procedure for the management of morbid obesity.     

Early and late complications following laparoscopic adjustable gastric banding

There is limited U.S. data on short- and long-term complications of laparoscopic adjustable gastric banding (LAGB) as a treatment option for morbid obesity. Hereafter, we present our experience with the first 154 consecutive LAGBs performed at Loyola University Medical Center. Inpatient and outpatient charts were reviewed retrospectively for all patients undergoing LAGB between November 2001 and February 2003 for perioperative morbidity and mortality and repeat operations. Thirty-seven men (24%) and 117 women (76%) underwent LAGB in a 16-month period. There was one (0.6%) death from postoperative myocardial infarction (MI) and one (0.6%) pulmonary embolism. Six (3.9%) patients required readmission to the hospital for dehydration. During a mean follow-up of 33 weeks (range, 4-69 weeks), 14 (9%) patients required repeat operations. There were five (3.2%) band slippages and one (0.6%) gastric erosion. Three bands were removed laparoscopically. Three slippages were revised laparoscopically. One patient underwent laparoscopic cholecystectomy. Seven patients (4.5%) required port revisions for catheter disconnection (4), leak at port site (2), or flipped port (1). LAGB is a safe operative approach for the management of morbid obesity. The incidence of postoperative complications can be minimal with application of a standardized technique. LAGB should be strongly considered for morbidly obese patients who have failed nonoperative management.     

腹腔镜可调节性胃束带术治疗肥胖症伴2型糖尿病的近期疗效

目的 观察腹腔镜可调节性胃束带术(laparoscopic adjustable gastric banding, LAGB)治疗病态肥胖症伴2型糖尿病的近期疗效.方法 对2006年10月至2007年8月收治的8例病态肥胖症伴2型糖尿病患者行LAGB治疗,监测术后1、3、6、9个月体质量变化,餐前空腹血糖和餐后2 h血糖变化,胰岛素及口服降糖药的使用情况.结果 8例患者术后体质量均减轻,术后9个月平均体质量指数由术前(38.7±7.5)k9/m2降至(30.5±4.3)kg/m2;6、9个月血糖水平明显下降,4例降至正常;9个月3例皮下注射胰岛素者改为口服降糖药物,4例停用降糖药物,1例注射胰岛素但减量.结论 LAGB能有效治疗病态肥胖症伴2型糖尿病,近期疗效良好.     

Ala55Val Polymorphism on UCP2 Gene Predicts Greater Weight Loss in Morbidly Obese Patients Undergoing Gastric Banding

BACKGROUND: Variability in weight loss has been observed from morbidly obese patients receiving bariatric operations. Genetic effects may play a crucial role in this variability. METHODS: 304 morbidly obese patients (BMI > or =39) were recruited, 77 receiving laparoscopic adjustable gastric banding (LAGB) and 227 laparoscopic mini-gastric bypass (LMGB), and 304 matched non-obese controls (BMI < or =24). Initially, all subjects were genotyped for 4 SNPs (single nucleotide polymorphisms) on UCP2 gene in a case-control study. The SNPs significantly associated with morbid obesity (P < 0.05) were considered as candidate markers affecting weight change. Subsequently, effects on predicting weight loss of those candidate markers were explored in LAGB and LMGB, respectively. The peri-operative parameters were also compared between LAGB and LMGB. RESULTS: The rs660339 (Ala55Val), on exon 4, was associated with morbid obesity (P = 0.049). Morbidly obese patients with either TT or CT genotypes on rs660339 experienced greater weight loss compared to patients with CC after LAGB at 12 months (BMI loss 12.2 units vs 8.1 units) and 24 months (BMI loss 13.1 units vs 9.3 units). However, this phenomenon was not observed in patients after LMGB. Although greater weight loss was observed in patients receiving LMGB, this procedure had a higher operative complication rate than LAGB (7.5% vs. 2.8%; P < 0.05). CONCLUSION: Ala55Val may play a crucial role in obesity development and weight loss after LAGB. It may be considered as clinicians incorporate genetic susceptibility testing into weight loss prediction prior to bariatric operations.     

Is a routine liquid contrast swallow following laparoscopic gastric banding mandatory?

Background: The authors assess the value of liquid contrast medium swallow as a method to detect postoperative complications after laparoscopic adjustable gastric banding (LAGB) for the treatment of morbid obesity. Methods: From January 1996 to January 2001, 350 morbidly obese patients (295 women, 55 men) underwent a LAGB operation. All data were prospectively collected in a computerized databank. All patients underwent a jopomidol swallow (JS) study in the early postoperative phase to exclude perforation of the esophagus or stomach, which is one of the most serious complications occurring after the LAGB operation. Furthermore, the JS was performed to confirm band position and to exclude early pouch dilatation. Results: Out of the 350 LAGB operations, 6(1.8%) early pouch dilatations and 4(1.2%) stomach perforations occurred. All early pouch dilatations were recognized on postoperative JS and immediately repaired laparoscopically. Of the perforations, one was recognized intraoperatively, and the other three were diagnosed postoperatively, either by contrast media extravasation on the JS (two patients) or by computer tomography. Conclusion: Presently,all patients undergo routine postoperative JS, which exposes them to radiation, causes patient discomfort, and entails additional costs of approximately 100 US$ per patient. Of the last 250 patients in our series, there have not been any cases of early pouch dilatation and since 1998 only one case of perforation has occurred, which could be easily suspected clinically. Therefore, we believe that in experienced centers, it is not necessary to perform routine postoperative contrast media studies and recommend JS only in cases of complicated postoperative courses.     

U.S. experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes

Background: Laparoscopic adjustable gastric band (LAGB) has consistently been shown to be a safe and effective treatment for morbid obesity, especially in Europe and Australia. Data from the U.S. regarding the LAGB has been insufficient. This study reveals our experience with 749 primary LAGB over a 3-year period in a U.S. university teaching hospital. Methods: All data was prospectively collected and entered into an electronic registry. Characteristics evaluated for this study include preoperative age, BMI, gender, race, conversion rate, operative time, hospital stay, percent excess weight loss (%EWL) and postoperative complications. Annual esophagrams were performed Results: From July 2001 through September 2004, 749 patients (531 females, 218 males) underwent LAGB for the treatment of morbid obesity. There were 630 Caucasians, 61 African-Americans, and 49 Latin Americans, with a mean age of 42.3 (range 18, 72 years) and mean BMI of 46.0 ± 7.0 (range 35, 91.5 kg/m²). There was one conversion to open (0.1%). Median operative time and hospital stay were 60 minutes and 23 hours, respectively. The mean %EWL at 1 year, 2 years, and 3 years was 44.4 (±17.8), 51.8 (±20.9), and 52.0 (±19.6), respectively. There were no mortalities. Postoperative complications occurred in 12.8% of patients: 1.5% acute postoperative band obstruction, 0.9% wound infection, 2.9% gastric prolapse (“slip”), 2.0% concentric pouch dilatation (without slip), 0.8% aspiration pneumonia, 2.4% port/tubing problems, 0.3% severe esophageal dilatation/dysmotility (reversible), and 1.5% overall band removal. Conclusion: These American results substantiate the data from abroad that LAGB is a safe and effective treatment for morbid obesity. Presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting, Fort Lauderdale, FL, USA, 14 April 2005