腹腔镜袖状胃切除在治疗肥胖及代谢综合征的疗效分析

目的探讨腹腔镜袖状胃切除（LSG）在治疗肥胖及代谢综合征的疗效，并分析其手术的安全性。 方法收集2014年11月至2018年1月期间长江大学医学院附属仙桃市第一人民医院肝胆外科的18例及昆明医科大学附属第二医院胃肠外科的32例，共50例接受LSG治疗的肥胖症患者的病例资料进行回顾性分析，通过术后4年随访，记录患者体重、实验室指标、合并症的改善、并发症的处理等数据等，统计分析患者术前及术后机体的代谢指标、微量元素的变化、合并症的缓解及并发症的处置结果等情况。 结果50例肥胖症患者均成功实施LSG，患者术后体重、体质量指数（BMI）、多余体质量减轻百分比（%EWL）等指标于术后3月出现明显下降（P<0.05），术后24月、36月、48月趋于稳定（P>0.05）；评价指标甘油三酯（TG）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）于术后6月改变明显，术后12月趋于稳定（P>0.05）；铁元素（Fe）、维生素B₁₂术前3月曾下降趋势（P<0.05），术后3月经过饮食调理及补充趋于稳定（P>0.05）。合并症情况，30例糖尿病患者空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）术后6月内逐渐下降（P<0.05），期间其中术后6月有27例完全缓解（90.0%），3例部分缓解（10.0%），术后4年内血糖趋于稳定（P>0.05）；术后2年内高血压，睡眠呼吸暂停综合征（OSA），多囊卵巢综合征得到了不同程度的缓解。术后近期严重并发症3例，远期并发症9例，通过相关处理后达临床治愈。 结论LSG对肥胖及代谢综合征效果显著，手术操作易行，并发症较少，在临床上值得推广。

Effectiveness of laparoscopic sleeve gastrectomy in treating obesity and metabolic syndrome.

ObjectiveTo probe the effectiveness of laparoscopic sleeve gastrectomy in treating obesity and metabolic syndrome and analysis its safety. MethodsFifty LSG patients from 18 cases of hepatobiliary surgery in Xiantao First People's Hospital Affiliated to Yangtze University and 32 cases of gastrointestinal surgery in the Second Hospital Affiliated to Kunming Medical University from November 2014 to January 2018 were collected for retrospective analysis. Through follow-up, part of the time was extended to 48 months. Patients' weight, laboratory indexes, remission and treatment of complications were recorded, and the preoperative and postoperative metabolic indexes, changes of trace elements, remission of complications and treatment results of complications were statistically analyzed. ResultsLaparoscopic sleeve gastrectomy was successfully performed in all 50 obese patients and none of them was transferred to laparotomy. Postoperative weight, body mass index (BMI), percentage of excess weight loss (%EWL) et al of the patients decreased significantly at 3 months after surgery (P<0.05), and tended to be stable at 24, 36 and 48 months after surgery (P>0.05). The laboratory indexes of triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were significantly changed at 6 months after the operation (P<0.05), and tended to be stable after 12 months after the operation (P>0.05). Fe and VitB12 had a decreasing trend 3 months after surgery (P<0.05), and became stable after 3 months after surgery though dieting and supplement (P>0.05). Complications: fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG) and glycosylated hemoglobin A1c (HbA1c) decreased gradually within 6 months after the operation (P<0.05), In this period, 27 patients had complete remission (90.0%) and 3 patients had partial remission (10.0%), and they tended to be stable in 48 months after the operation (P>0.05).Hypertension, obstructive sleep apnea (OSA) and polycystic ovary syndrome were relieved to varying degrees within 2 years after surgery. There were 3 cases of short-term serious complications and 9 cases of long-term complications after surgery were achieved clinic crue after relevant treatment. ConclusionsLaparoscopic sleeve gastrectomy has a significant effect on obesity and metabolic syndrome, and the surgical operation is not complicated with fewer complications. Therefore, it is worthy of promotion in clinical practice.