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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2016, Vol. 09 ›› Issue (06) : 331 -334. doi: 10.3877/cma.j.issn.1674-6899.2016.06.004

所属专题： 文献；

论著

腹腔镜袖状胃切除术与胃旁路术治疗重度肥胖症：单中心3年临床疗效分析
杜潇1, 傅湘辉2, 石磊3, 庄华4, 胡建昆1, 周总光1, 程中1,†()   
  1. 1. 610041　成都，四川大学华西医院胃肠外科
    2. 610041　成都，四川大学华西医院内分泌代谢科　生物治疗国家重点实验室　生物治疗协同创新中心
    3. 610041　成都，四川大学华西医院营养科
    4. 610041　成都，四川大学华西医院超声科
  • 收稿日期:2016-11-14 出版日期:2016-12-30
  • 通信作者: 程中
  • 基金资助:
    国家自然科学基金(81502613); 四川省科技支撑计划项目(2014SZ0002－5); 新都区社会事业科技计划项目(20160740401)

Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: outcomes of 3-year follow-up

Xiao Du1, Xianghui Fu2, Lei Shi3, Hua Zhuang4, Jiankun Hu1, Zongguang Zhou1, Zhong Cheng1,†()   

  1. 1. Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
    2. Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy, Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
    3. Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu 610041, China
    4. Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2016-11-14 Published:2016-12-30
  • Corresponding author: Zhong Cheng
  • About author:
    Corresponding author: Cheng Zhong, Email:
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杜潇, 傅湘辉, 石磊, 庄华, 胡建昆, 周总光, 程中. 腹腔镜袖状胃切除术与胃旁路术治疗重度肥胖症：单中心3年临床疗效分析[J/OL]. 中华腔镜外科杂志(电子版), 2016, 09(06): 331-334.

Xiao Du, Xianghui Fu, Lei Shi, Hua Zhuang, Jiankun Hu, Zongguang Zhou, Zhong Cheng. Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: outcomes of 3-year follow-up[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2016, 09(06): 331-334.

目的

回顾性分析比较腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy, LSG)与腹腔镜Roux－en－Y胃旁路术(laparoscopic Roux－en－Y gastric bypass，LRYGB)用于手术治疗重度肥胖症3年疗效。

方法

纳入从2009年1月至2013年5月在四川大学华西医院接受手术治疗肥胖症的患者，比较术后12、24、36个月的手术安全性、多余体质量下降百分比(percentage of excess weight loss, EWL%)、术后体质量指数等。

结果

74例患者接受LRYGB(LRYGB组)，82例患者接受LSG(LSG组)，术前两组患者的基线临床数据相当。LSG组的手术时间及住院时间显著少于LRYGB组，两组严重并发症发生率比较，差异无统计学意义。术后12、24个月时两组的体质量指数及EWL%比较，差异无统计学意义。术后36个月，LRYGB组的EWL%显著高于LSG组[(74.7 ± 8.3)% vs (69.1 ± 10.7)%]、体质量指数显著低于LSG组[(28.3 ± 1.6) kg/m2 vs (28.9 ± 1.8) kg/m2]，两组比较，差异有统计学意义(P<0.05)。

结论

与经典LRYGB相比，LSG同样为安全有效的减重术式。但LRYGB在中期减重疗效上优于LSG。

关键词: 减重手术, 重度肥胖, 减重, 袖状胃切除术, 胃旁路术
Objective

A retrospective cohort study with 3-year follow-up aimed to compare the safety and efficacy of LSG with LRYGB for morbid obesity.

Methods

From Jan. 2009 to May. 2013, 74 patients undergoing LRYGB and 82 patients undergoing LSG were enrolled in this study. Major complications, BMI, and percentage of excess weight loss (EWL%) after 12, 24, and 36 months were compared.

Results

The preoperative characters of patients between two groups were comparable. Hospital stay and operative time in LSG was significantly shorter than LRYGB group, and there was no significant difference of major complications. No significant differences in mean percentage of excess weight loss, EWL% and BMI were observed at 12, 24 months. At 3-year follow-up, mean EWL% in the LRYGB group was significantly higher than in the LSG group [(74.7±8.3)% vs (69.1±10.7)%] and, consequently, mean BMI was significantly lower in LRYGB [(28.3 ± 1.6) kg/m2 vs (28.9 ± 1.8) kg/m2, P<0.05].

Conclusions

LSG were safe and effective bariatric procedures compared with LRYGB, but LRYGB was superior to LSG in terms of mid-term weight loss.

Key words: Bariatric surgery, Morbid obesity, Weight loss, Sleeve gastrectomy, Roux-en-Y gastric bypass
表1 肥胖患者的两组临床资料比较
项目 腹腔镜胃旁路术组(74例) 腹腔镜袖状胃切除术组(82例) P值
性别(男性/女性，例) 28/46 35/47 0.54
年龄(岁，±s) 36.7 ± 8.3 34.1 ± 9.6 0.07
体质量指数(kg/m2，±s) 37.4 ± 5.1 38.7 ± 5.5 0.13
腰围(cm，±s) 95.4 ± 6.7 96.5 ± 7.9 0.35
合并症[例(%)] ? ? ?
? 2型糖尿病 23 (31.1) 15 (18.3) 0.06
? 高血压 28 (37.8) 30 (36.6) 0.87
? 高脂血症 37 (50.0) 38 (46.3) 0.65
? 高尿酸血症 12 (16.2) 18 (22.0) 0.36
手术时间 (min，±s) 112.2 ± 18.5 78.6 ± 20.2 <0.01
住院时间 (d，±s) 4.8 ± 4.7 3.5 ± 1.6 0.02
严重并发症[例(%)] 2 (2.7) 0 (0) >0.99
表2 肥胖患者的两组术前、术后随访体质量指数比较(kg/m2, ±s)
项目 例数 术前 术后12个月 术后24个月 术后36个月
腹腔镜胃旁路术组 74 37.4 ± 5.1 27.8 ± 1.6 28.0 ± 1.4 28.3 ± 1.6
腹腔镜袖状胃切除术组 82 38.7 ± 5.5 28.1 ± 1.7 28.3 ± 1.7 28.9 ± 1.8
P值 ? 0.13 0.28 0.17 0.01
表3 肥胖患者的两组术后随访多余体质量下降百分比的比较(%，±s)
项目 例数 术后12个月 术后24个月 术后36个月
腹腔镜胃旁路术组 74 82.3 ± 8.0 77.1 ± 8.3 74.7 ± 8.3
腹腔镜袖状胃切除术组 82 79.3 ± 10.0 75.9 ± 9.8 69.1 ± 10.7
P值 ? 0.19 0.41 < 0.01
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