腹腔镜胃旁路术对肥胖患者脂质代谢的影响

目的：分析腹腔镜下胃旁路术肥胖患者术前及术后脂质代谢情况。方法从2010年10月至2012年12月在南京医科大学第一附属医院减重中心接受胃旁路手术的肥胖患者（ BMI＞28 kg／m^2）25例，手术时保留30 ml小胃囊，旷置100 cm胆胰支及100～200 cm食物支。回顾性分析术前及术后1、3、6、9、12个月血浆总胆固醇（ TC）、甘油三酯（ TG）、高密度脂蛋白（ HDL）及低密度脂蛋白（ LDL）的随访数据，记录并发症情况。结果25例肥胖患者手术均在腹腔镜下完成，随访超过一年，均未发生严重并发症。术后TC，TG，LDL均出现显著降低（P＜0.05），HDL出现显著升高（P＜0.05）。术前仅HDL与BMI相关（P＜0.05），术后TG、LDL、HDL改变均与多余体重减少率（PEWL）相关（P＜0.05）。结论腹腔镜胃下旁路术是一种安全的手术方式，在减重同时会给肥胖患者的脂质代谢带来改善，降低血浆TC、TG及LDL，增加HDL水平。

Effects of laparoscopic gastric bypass surgery on lipid metabolism in obese patients

Objective To assess the lipid profiles of obese patients undergoing laparoscopic gastric by-pass surgery.Methods A retrospective observational study was performed , involving 25 patients（BMI〉28 kg/m^2 ） who consecutively underwent gastric bypass surgery in the First Affiliated Hospital of Nanjing Medical University from Oct.2010 to Dec.2012.For the surgery, a small gastric pouch about 30 ml was performed with 100 cm biliopancreatic limb and 100-200 cm alimentary limb.Total cholesterol（TC）,triglycerides（TG）,high density lipoprotein（ HDL） and low density lipoprotein （ LDL） at baseline and 1, 3, 6, 9 and 12 months after surgery were measured.Related complications were recorded .Results All surgeries were performed laparoscopically and no serious complications occurred .TC, TG, and LDL significantly reduced after the surgery （P〈0.05 for all）.Inversely, HDL disclosed a significant rise（P〈0.05）.Of the lipid profiles at baseline, only HDL concentration displayed a correlation with BMI .Percentage of excess weight loss （ PEWL ） displayed significant correlation with the variety of TG、LDL、HDL after surgery（P〈0.05 for all）.Conclusions Laparoscopic gastric bypass is a safe operation which improves the lipid metabolism of obese patients .The operation can decrease the concentration of TC, TG, LDL and increase HDL level .