腹腔镜可调节性胃束带术治疗病态肥胖症的近期疗效

目的 了解腹腔镜可调节性胃束带术(laparoscopic adjustable gastric banding,LAGB)治疗病态肥胖症及伴发病的近期疗效. 方法 2006年10月至2007年12月,对50例病态肥胖症患者(其中伴发2型糖尿病11例、高血压3例、血脂异常15例、脂肪肝28例、睡眠呼吸暂停综合征1例和胆囊结石2例)行LAGB治疗,术后随访6～18个月,平均11.2个月,观察减重效果、伴发病变化及并发症发生情况.结果 术后9个月、12个月和18个月平均体质量指数由术前(39±6)ks/m2分别降至(31±4)kg/m2、(28±7)kg/m2和(27±7)kg/m2(P＜0.05);术后平均超重体重减重百分比分别为30%±11%、42%±13%和45%±13%;术后12个月和18个月超重体重减重百分比＞50%的人数分别达到20%和44%,66%～100%的患者术后12个月和18个月其肥胖相关伴发疾病得到完全缓解或好转.术后发生并发症4例,其中3例经保守治疗、1例经再次手术治疗痊愈.结论 LAGB是一种安全、有效和可行的治疗肥胖症及其相关伴发疾病的方法.     

腹腔镜可调控性胃束带术治疗肥胖伴2型糖尿病的机制研究

目的 探讨腹腔镜可调控性胃束带术（LAGB）治疗肥胖症伴2型糖尿病（T2DM）的相关机制.方法 采用LAGB治疗20例肥胖症伴T2DM患者.术后第1、3、6、9、12个月监测术后体质量并计算BMI;采用ELISA检测血清瘦素、胰高血糖素样肽-1（GLP-1）及生长激素释放多肽（ghrein）的水平;采用电化学发光法检测空腹血清胰岛素（FINS）、C肽、糖化血红蛋白（HbA1c）的水平;采用氧化酶法检测空腹血糖（FBG）水平;对血清瘦素、GLP-1及ghrein水平与糖尿病相关指标进行相关性检验.结果 本组20例患者LAGB术后12个月,体质量由术前的（108±18）kg降至（71±16）kg （P＜0.05）,BMI由术前的38±5降至29±6（P＜0.05）;胰岛素抵抗指数由术前的12.8±7.4降至3.4±2.0（P＜0.01）;血清ghrelin水平由术前的（7.8±1.9）μg/L升至（11.6±2.6）μg/L（P＜0.01）,血清瘦素水平由术前（24.9±13.7）μg/L降至（12.9±5.1）μg/L（P＜0.01）,GLP-1水平由术前的（0.58±0.12）μg/L升至（0.80±0.06）μg/L（P＜0.01）;血清瘦素水平与糖尿病相关指标（FBG、FINS、C肽及HbA1c）呈正相关,而血清Ghrelin和GLP-1水平则与上述糖尿病相关指标呈负相关（均P＜0.01）.结论 LAGB能有效治疗肥胖伴T2DM,其可能的机制是通过升高血清GLP-1和ghrelin水平,降低血清瘦素水平,减轻胰岛素抵抗,从而达到降低血糖的目的 .     

腹腔镜Roux-en-Y胃旁路手术治疗肥胖症和2型糖尿病

目的 探讨腹腔镜Roux-en-Y胃旁路手术（LRYGB）治疗肥胖症和（或）2型糖尿病的可行性及疗效.方法 对21例单纯性肥胖症及9例2型糖尿病患者施行LRYGB,观察肥胖症患者体质量、BMI、超重体质量减少率（EWL%）改善情况;观察糖尿病患者术后的空腹血糖和口服葡萄糖耐量试验（OGTT）变化情况;观察全组患者手术时间、术中出血量、术后恢复、术后并发症情况.结果 本组30例皆成功完成手术,无中转开放手术者,手术时间110～270（平均168）min.术中出血量10～75（平均24.0）ml.本组21例单纯性肥胖症患者术前体质量及BMI分别为（97.2±15.0）kg和35.3±3.5;术后随访2个月至5年,术后1个月体质量及BMI即显著下降[（85.1±10.1）kg和31.2±2.2,均P〈0.01],至术后2～3年降至最低水平[（66.8±9.2）kg和24.3±1.1],之后维持在此水平;EWL%则相应增高（均P〈0.05）.9例2型糖尿病患者术前空腹血糖及OGTT 2 h血糖分别为（12.6±2.6）mmol/L和（17.8±4.1）mmol/L;术后随访3～8个月,空腹血糖及OGTT2 h血糖均显著下降[（5.9±1.4）mmol/L和（7.8±1.4）mmol/L,均P〈0.05];其中合并肥胖症的4例患者BMI明显降低（P〈0.05）,而5例未合并肥胖症者BMI无明显变化（P〉0.05）.本组30例患者中5例（16.7%）术后出现并发症,其中1例因急性暴发性胰腺炎死亡外,1例因肠系膜裂孔疝致肠梗阻行再次手术治愈,余3例均经保守治疗治愈.结论 LRYGB治疗肥胖症和（或）2型糖尿病手术安全可行,术后近期减重和（或）降糖效果显著.     

腹腔镜可调节胃束带术与胃袖状切除术治疗肥胖症合并2型糖尿病的近期疗效比较

目的 比较腹腔镜下可调节胃束带术（LAGB）与腹腔镜胃袖状切除术（LSG）治疗肥胖症合并2型糖尿病的近期减重及降糖疗效,并初步分析两种术式减重与降糖疗效间的关系.方法 回顾性分析2010年1月至201 1年12月上海第二军医大学附属长海医院收治的40例肥胖症合并2型糖尿病患者的临床资料.其中行LAGB 14例（LAGB组）,行LSG 26例（LSG组）.采用门诊及远程随访的方式比较两种术式术后1年时间内的减重及降糖疗效.两组术前情况比较采用配对t检验,两组间比较采用重复测量的双变量多因素方差分析,减重及降糖疗效相关性采用线性回归分析.结果 两组患者均经腹腔镜完成手术,无中转开腹,无术中并发症发生.LAGB组患者手术时间为（69±16） min,术中出血量为（31±14） mL.LSG组患者手术时间为（120 ± 15） min,术中出血量为（148±48）mL.两组患者术后均未发生营养不良、电解质紊乱、胃排空障碍、出血、吻合口漏等严重并发症.有2例患者术后出现局部伤口脂肪液化,经换药后愈合.（1）减重疗效：LAGB组和LSG组患者术后体质量、BMI、腰围均呈下降趋势.LAGB组患者术后体质量、BMI、腰围由术前的（117 ±28）kg、（40±8）kg/m2、（118±15）cm下降为术后48周的（94±28）kg、（33±8）kg/m2、（92±15） cm;LSG组患者上述指标由术前的（119±25）kg、（42±6） kg/m2、（123±14） cm下降为术后48周的（74±16） kg、（26±4） kg/m2、（86±13）cm.两组患者多余体质量减少率（EWL）呈上升趋势.LAGB组患者EWL由术后1周7％±2％上升为术后48周的53％±24％,LSG组患者EWL由术后1周11％±4％上升为术后48周的90％±20％.两组上述指标变化趋势比较,差异有统计学意义（F=60.660,74.490,57.650,90.020,P＜0.05）.（2）降糖疗效：LAGB组患者术后糖化血红蛋白、空腹血糖、空腹胰岛素、胰岛素抵抗指数、TG、TC、LDL、HDL由术前的8.1     

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。     

腹腔镜Roux-en-Y胃分流术治疗病态性肥胖合并2型糖尿病

目的 评价腹腔镜Roux-en-Y胃分流术(LRYGB)对病态性肥胖合并2型糖尿病患者的治疗效果,探讨该术式治疗糖尿病的可能机制.方法 前瞻性分析2007年1月至7月美国克利夫兰医院30例体质量指数(BMI)≥35.00合并2型糖尿病的病态性肥胖患者的临床资料,采用t检验分析患者接受LRYGB后的疗效.结果 与术前比较,术后第6个月的BMI、空腹血糖、糖化血红蛋白明显降低(t=27.399,23.025,15.593,P＜0.05).第2个月治愈率为70%(21/30),第6个月治愈率为90%(27/30),3例糖尿病症状得到改善.进一步分析术后第2个月和第6个月体质量下降程度,改善患者分别为27.89%±5.51%、45.73%±2.82%,治愈患者分别为35.65%±1.97%、58.00%±1.05%,糖尿病治愈患者比改善患者下降幅度大(t=5.755,7.081,P＜0.05).结论 LRYGB对病态性肥胖合并2型糖尿病患者有着良好治疗效果,体质量下降幅度越大,糖尿病治愈可能性就越大.     

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。     

腹腔镜可调节胃束带术治疗肥胖病伴2型糖尿病21例疗效分析

目的 观察评价腹腔镜可调节胃束带术（LAGB）治疗肥胖病伴2型糖尿病的临床效果。方法 回顾分析2005-2007年天津市南开医院微创外科中心对21例肥胖病伴2型糖尿病病人施行LAGB的临床资料,观察分析手术前后病人体重、体重指数（BMI）及空腹血糖等指标变化。 结果 21例手术均获成功,未发生围手术期严重并发症。术后随访1年,体重从平均106.7（±13.8）kg降至93.8（±10.6）kg;体重指数从平均37.2（±3.6）降至32.4（±2.1）, 空腹血糖从平均8.60（±2.1）mmol/L降至7.80（±2.2）mmol/L,体重下降明显,但糖尿病缓解不明显。随访2年,平均体重降至85.2（±11.8）kg;平均体重指数降至 29.4（±2.8）, 平均空腹血糖降至5.86（±1.7）mmol/L,体重下降及糖尿病缓解均明显。结论 LAGB术后2年疗效可靠,平均体重下降20.1%, 糖尿病缓解率76%,是治疗肥胖病伴2型糖尿病的有效方法。     

胃转流手术治疗2型糖尿病的可行性

目的对病态肥胖症手术对2型糖尿病的影响及其作用机制做一综述, 同时探讨病态肥胖症手术是否也可用于治疗不伴有肥胖症的2型糖尿病病人. 背景资料全世界有超过1.5亿人罹患2型糖尿病,虽然对高血糖的严格控制使得2型糖尿病并发症的发生率大大减少,但目前的治疗方法还不能达到根治.某些用于治疗病态肥胖症的手术不仅导致显著而持久的体重下降,而且使2型糖尿病得以缓解. 方法复习文献,回顾分析肥胖症手术对继发的糖代谢和内分泌变化的影响. 结果胃转流和胆胰转流术后数天内,80%～100%严重肥胖的糖尿病病人血糖、血胰岛素和糖化血红蛋白达正常水平,胃肠道激素分泌形式发生显著变化.病例报道也证实因其它因素施行胆胰转流的非病态肥胖患者避免罹患2型糖尿病.结论胃转流和胆胰转流术似乎对控制2型糖尿病有原发的、独立的影响,而不是继发于对肥胖症的治疗.虽然还需要对不伴肥胖患者进行对照研究,但胃转流手术的确有可能改变当前对2型糖尿病病理生理的理解,甚至改变该病的治疗方法.     

袖状胃切除间置回肠的十二指肠空肠旁路手术治疗非肥胖型2型糖尿病

目的 评价袖状胃切除间置回肠的十二指肠空肠旁路手术对非肥胖型2型糖尿病的治疗效果.方法 对符合纳入标准的非肥胖型2型糖尿病患者41例实施袖状胃切除间置回肠的十二指肠空肠旁路手术.观察术前及术后1、3、6个月患者的空腹血糖、餐后2h血糖、糖化血红蛋白、空腹胰岛素、空腹C肽、胰岛素抵抗指数(Homa-IR)、甘油三酯、高密度脂蛋白、低密度脂蛋白的变化及糖尿病并发症的缓解情况.结果 对本组41例患者平均随访时间9.6个月(6～21个月).95％的患者术后糖化血红蛋白＜7％,不需任何降糖药物.78％的患者糖化血红蛋白＜6％.空腹血糖从术前的(9.7±0.4) mmol/L降至术后的(6.2±0.3)mmol/L(P＜0.01);糖化血红蛋白从术前的8.1％±1.4％降至术后的5.8％±0.6％(P＜0.01);餐后2h血糖从术前的(13.6±0.7) mmol/L降至术后的(10.6±0.2) mmol/L(P＜0.01);Homa-IR从术前的4.8±1.3降至术后的1.2±0.4(P＜0.01);空腹C肽从术前的(3.3±1.7) ng/ml升至术后的(4.9±0.2) ng/ml(P ＜0.01);空腹胰岛素从术前的(10.2±1.4) mlu/L升至术后的(15.6±0.7) mlu/L(P ＜0.01)L;甘油三酯从术前的(3.1±0.5) mmol/L降至术后的(1.9±0.4) mmol/L(P ＜0.01);高密度脂蛋白从术前的(1.2±0.2) mmol/L升至术后的(1.9±0.8) mmol/L(P ＜0.01);低密度脂蛋白从术前的(3.5±0.3)mmol/L降至术后的(2.4±0.6)mmol/L(P＜0.01).7例合并高血压患者中3例的血压得到控制.78％(21/27例)患者的尿微量白蛋白得到缓解.53％(8/15例)患者的糖尿病视网膜病变得到改善.结论 袖状胃切除间置回肠的十二指肠空肠旁路手术治疗非肥胖型2型糖尿病短期效果良好.     

Weight loss and changes in use of antidiabetic medication in obese type 2 diabetics after laparoscopic gastric banding

BackgroundInterest in bariatric surgery is growing as an effective method for long-term metabolic control in morbidly obese patients with type 2 diabetes. We analyzed the weight loss and changes in use of diabetic medication in obese patients with type 2 diabetes treated with laparoscopic adjustable gastric banding (LAGB).MethodsFrom 1993 to 2005, 1791 morbid obese patients underwent LAGB at our institution. Of the 1791 patients, 394 (22%) had type 2 diabetes mellitus at baseline. Of the 394 patients with diabetes, 52 were receiving diabetic medication. The median follow-up period for the drug-treated diabetic patients was 3 years (range .25–9).ResultsThe drug-treated diabetic patients were older (age 47.6 ± 7.5 versus 37.5 ± 10.7 years, P <.001), weighed more (body mass index 49.1 ± 9.5 versus 45.6 ± 7.5 kg/m², P 0.001), and were more frequently affected by co-morbidities than the nondiabetic patients at surgery. The percentage of excess weight loss 1 year after surgery was less (32.4% ± 14.1% versus 41.1% ± 19.9%, P <.01) for the drug-treated diabetic patients than for the nondiabetic patients. This difference was maintained for 5 years of follow-up. A significant decline occurred in the use of both oral diabetic medication and insulin after surgery. Of the 52 patients treated with oral antidiabetic medication at baseline, 33 required oral antidiabetic medication at the end of follow-up. Of the 6 patients who also required insulin at baseline, 2 did so at the end of follow-up. The use of diabetic medication had increased in 4 patients (7.7%), was unchanged in 12 (23.1%), had decreased in 17 (32.7%), and was suspended in 19 (36.5%) of 52 patients.ConclusionThe amount of weight loss after LAGB was less in drug-treated diabetic patients than in nondiabetic patients. However, LAGB was associated with a sustained reduction in the use of diabetic medication.     

Comparison Between Laparoscopic Sleeve Gastrectomy and Laparoscopic Adjustable Gastric Banding for Morbid Obesity: a Meta-analysis

Bariatric surgery is now widely accepted for treatment of morbid obesity. This study compared the effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) on excess weight loss (EWL) and type 2 diabetes mellitus (T2DM). PubMed and Embase were searched for publications concerning LAGB and LSG from 2000 to 2012, with the last search on August 17, 2012. EWL and T2DM improvement over 6 and 12 months were pooled and compared by meta-analysis. Odds ratios (ORs) and mean differences were calculated with 95 % confidence intervals (CIs). Eleven studies involving 1,004 patients met the inclusion criteria. Compared with LAGB, LSG achieved greater EWL. The mean percentage EWL for LAGB was 33.9 % after 6 months in six studies and 37.8 % after 12 months in four studies; for LSG, EWL was 50.6 % after 6 months and 51.8 % after 12 months in the same studies. LSG was also superior to LAGB in treating T2DM. In five studies, T2DM was improved in 42 of 68 (61.8 %) patients after LAGB and 66 of 80 (82.5 %) after LSG, representing a pooled OR of 0.34 (95 % CI 0.16–0.73) and pooled mean differences of ?12.55 (95 % CI ?15.66 to ?9.43) and ?4.97 (95 % CI ?7.58 to ?8.36), respectively. LSG is more effective than LAGB in morbid obesity, with higher percentage EWL and greater improvement in T2DM.     

Behavior of Type 2 Diabetes Mellitus in Morbid Obese Patients Submitted to Gastric Bypass

Introduction Surgical treatment of obesity has not only resulted in weight loss, but also the control of associated diseases in the postoperative period. The aim of this study was to determine the post-op response of type 2 diabetes mellitus (DM2) to gastric bypass. Methods A historical cohort study was performed involving all the diabetic, morbid obese patients who underwent gastric bypass during the period of May 2000 to October 2006 at the Centro da Obesidade Mórbida. Patient records were reviewed with regard to sex, age, anthropometric measurements, glycemia, glycosylated hemoglobin, pre-op insulin, and DM2 outcome. Results A total of 125 diabetic, morbid obese patients were operated; they had a mean age of 42.6 ± 9.7 years and body mass index of 49 ± 8.3 kg/m². Of these patients, 63 (50.4%) required medication for control of DM2, and the rest managed only with diet. Of these 63 patients, 43 (68.2%) achieved control of DM2 and were discharged without the need for antidiabetic medication, and 20 (31.7%) were discharged still on medication. One month after surgery, seven more patients discontinued medication for DM2, and 18 months after surgery, 97.6% of the patients showed control of DM2. Conclusion Gastric bypass is effective in controlling DM2 in morbid obese patients.     

Elevated Concentrations of Liver Enzymes and Ferritin Identify a New Phenotype of Insulin Resistance: Effect of Weight Loss After Gastric Banding

BACKGROUND: Several studies have associated elevated liver enzymes (LFTs), obesity, and type 2 diabetes (T2DM), and a link has been established between insulin resistance (IR) and elevated ferritin concentrations. We examined the relationship between LFTs, ferritin, and IR in morbid obese subjects and the effect of weight loss after bariatric surgery. METHODS: We measured liver enzymes, ferritin, insulin resistance, and glucose tolerance (by OGTT) in 159 morbid obese subjects (BMI = 44.4 +/- 0.4 kg/m(2)) at baseline, 6 months and 1 year after laparoscopic-adjustable-gastric banding (LAGB). Subjects were divided in two groups: increased LFTs (ALT > 30; AST/ALT < 1) vs. normal LFTs. RESULTS: A large proportion of morbid obese subjects had increased LFTs (44%) which were associated with increased IR and ferritin, suggesting potential liver disease. A majority of the morbidly obese with increased LFTs, IGT, and T2DM, were male and had almost double ferritin concentrations, strongly correlated with ALT (r = 0.43, p < 0.0001). Both ferritin and ALT correlated with waist circumference and IR. One year after, LAGB glucose tolerance improved, LFTs and IR were reduced; ferritin did not change significantly, but was still correlated with IR. CONCLUSIONS: Ferritin may be an additional useful marker for more severe hepatic IR.     

The effects on oxidative DNA damage of laparoscopic gastric band applications in morbidly obese patients

Background

Obesity may induce oxidative stress, causing oxidative damage of DNA. We examined associations between decreasing serum and urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) levels and weight loss in morbidly obese patients before and 6 months after laparoscopic adjustable gastric banding (LAGB).

Methods

We compared patients who had surgery for morbid obesity with healthy, nonobese controls. Urine and fasting blood samples were collected once from the controls and from the morbidly obese patients before and 6 months after the LAGB. The serum and urinary 8-OHdG levels were evaluated in these groups using an enzyme-linked immunosorbent assay kit.

Results

We included 20 patients who had surgery for morbid obesity (8 men, 12 women, mean body mass index [BMI] 46.82 ± 4.47) and 20 healthy, nonobese people (10 men, 10 women, mean BMI 22.52 ± 2.08) in our study. There was no significant difference in serum 8-OHdG levels between the groups, whereas urinary 8-OHdG levels were significantly higher in morbidly obese patients than in controls. Weight, BMI and serum and urinary 8-OHdG levels were significantly decreased in morbidly obese patients 6 months after LAGB.

Conclusion

The LAGB provides efficient weight loss in patients with morbid obesity. The systemic oxidative DNA damage was increased by the morbid obesity, but this increase was not related to weight gain, and it was more evident in serum than urine samples. After LAGB for morbid obesity, the oxidative DNA damage declined both in serum and urine.