多科协作模式下腹腔镜可调节胃束带术治疗病态肥胖症临床分析

目的探讨肥胖症综合治疗的多科协作模式，分析该模式下腹腔镜可调节胃束带术的安全性及对病态肥胖症及其合并症的治疗效果。方法回顾性分析2009年10月至2012年5月在多科协作模式下由北京协和医院基本外科连续施行腹腔镜可调节胃束带术的28例病态肥胖症患者的临床资料和术后随访数据，总结多科协作模式下肥胖症患者的围手术期和术后随访管理流程，观察手术安全性和术后长期减重效果及合并症的改善情况。结果本组平均体重129．1kg，平均体质指数44．9kg／m^2.全部患者均顺利施行手术，未出现围手术期死亡病例。术后早期并发症1例（3．6％）肺部感染，远期并发症2例（7．1％）注水泵处皮肤感染。术后体重和体质指数逐渐下降，术后24个月平均额外体重减轻41．3％。规律随诊、依从性良好组额外体重减轻百分比显著高于不规律随诊、依从性差组。术后肥胖症相关代谢性疾病均有不同程度改善。结论腹腔镜可调节胃束带术安全可靠，并发症少，可有效减重，并能改善肥胖症相关代谢性疾病；多科协作模式可优化疾病诊治流程，保障围手术期安全；术后规律随诊对获得长期减重效果有重要影响。

Laparoscopic adjustable gastric banding in a multidisciplinary modality for morbid obesity

Objective To investigate the multidisciplinary modality for obesity treatment and evaluate the safety and long-term efficacy of laparoscopic adjustable gastric banding（LAGB） on weight loss and obesity related metabolic diseases in obesity patients. Methods The clinical and follow-up data of 28 consecutive morbid obesity patients receiving LAGB in Dept. General Surgery of PUMC hospital in a muhidisciplinary modality from Oct 2009 to May 2012 were retrospectively analyzed. The strategy of perioperative and follow-up management was summarized and the safety and long-term efficacy of LAGB on weight loss and comorbidity were evaluated. Restilts Mean body weight of the subjects was 129. lkg and mean body mass index（ BMI）44. 9 kg/m2. All patients underwent LAGB successfully without perioperative mortality. Early postoperative complications included 1 case （3.6%） of pulmonary infection and long-term complications included 2 cases （7.1%）of port infection. Mean body weight and BMI decreased gradually after LAGB. The mean percentage of excess weight loss （ % EWL） at postoperative 24 months was 41.3%. % EWL of the group with regular follow-up and good compliance was significantly better than the other group. Complete or partial remission was observed in obesity related metabolic diseases at the last follow-up. Conclusions LAGB is safe and has good long-term efficacy on weight loss and comorbidity improvement of obesity patients. Better services can be provided for obesity patients in a multidisciplinary modality. It is important for the patients to follow up regularly after surgery in order to maintain long-term weight loss.