两种腹腔镜代谢手术方法治疗超级肥胖患者30例分析

目的探讨两种代谢手术治疗超级肥胖的疗效及安全性。 方法回顾性分析2011年3月至2017年11月30例超级肥胖患者的临床资料和随访资料。根据手术方式不同，分为腹腔镜袖状胃切除术组(LSG，9例)和腹腔镜Roux－en－Y胃旁路术组(LRYGB，21例)。数据采用SPSS21.0统计分析，术前术后各项指标、额外体重减轻百分比(%EWL)用( ±s)表示，独立t检验；术后早期及远期并发症、代谢合并症的改善情况使用χ²检验；P<0.05差异有统计学意义。 结果30例患者均成功完成腹腔镜手术，无中转开腹。两组患者在术后6个月内%EWL上升明显，之后上升缓慢。LSG组少于LRYGB组(P<0.01)，提示LRYGB组的短期减重疗效优于LSG组。LSG组1例患者术后第2天出现胃切缘出血，再次手术修补。LRYGB组1例患者术后6个月出现脱发和骨质疏松，两组术后早期及远期并发症差异无统计学意义(P>0.05)。 结论两种代谢手术治疗超级肥胖及其合并症短期内安全有效。

Therapuetic Treatment of super obesity by laparoscopic metabolic surgery,report of 30 cases

Objective To investigate the efficacy and safety of two types of laparoscopic metabolic surgery in treating super obesity.Methods Form March 2011 to November 2017,clinical data of 30 patients with super obesity were analyzed retrospectively.There were 9 cases underwent laparoscopic sleeve gastrectomy(LSG group)and 21 cases received laparoscopic Roux-en-Y gastric bypass(LRYGB group).Statistical analysis were performed by using SPSS 21.0 software package.Measurement data such as perioperative indicators,postoperative clinical indicators and Percentage of extra weight loss(%EWL)were expressed as (x±s) and examined by using independent t-test.Count data such as short-and long-term complication rate and efficacy were compared by usingχ^2 test.A P value of<0.05 was considered as statistically significant difference.Results 30 patients underwent laparoscopic surgery successfully without conversion to open surgery.The%EWL of the two groups increased significantly within 6 months after operation,and then increased slowly.LSG group was less than LRYGB group(P<0.01),suggesting that the short-term weight loss effect of LRYGB group was better than LSG group.One patient in LSG group had bleeding at the cutting edge of stomach 2 days after operation,and underwent reoperation.One patient in LRYGB group had alopecia and osteoporosis 6 months after operation.There was no significant difference in the early and long-term complications between the two groups(P>0.05).Conclusions Both LSG and LRYGB for the treatment of super obesity are safe and effective during short term follow-up period.