切换至 "中华医学电子期刊资源库"
高级检索
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： 文献资源库；

论著 上一篇    下一篇

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 Du 1, Xianghui Fu 2, Lei Shi 3, Hua Zhuang 4, Jiankun Hu 1, Zongguang Zhou 1, Zhong Cheng 1 , †( )   

  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:
全文 ( ) 下载PDF ( )
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
1
Poloz Y, Stambolic V. Obesity and cancer, a case for insulin signaling [J]. Cell Death & Disease, 2015, 6 (12): 2037.
2
O′Rourke RW. Obesity and cancer: at the crossroads of cellular metabolism and proliferation [J]. Surg Obes Relat Dis, 2014, 10 (6): 1208-1219.
3
Mitka M. Bariatric surgery continues to show benefits for patients with diabetes [J]. Jama the Journal of the American Medical Association, 2012, 307 (18): 1901-1902.
4
Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013 [J]. Obesity Surgery, 2015, 25 (10): 1822-1832.
5
Boza C, Gamboa C, Salinas J, et al. Laparoscopic roux－en－y gastric bypass versus laparoscopic sleeve gastrectomy: a case－control study and 3 years of follow－up [J]. Surgery for Obesity & Related Diseases Official Journal of the American Society for Bariatric Surgery, 2012, 8 (3): 243-249.
6
刘金刚，郑成竹，王勇．中国肥胖和2型糖尿病外科治疗指南 (2014) [J]. 中国实用外科杂志，2014, 8 (11): 499-504.
7
Buwen JP, Kammerer MR, Beekley AC, et al. Laparoscopic sleeve gastrectomy: the rightful gold standard weight loss surgery procedure [J]. Surgery for Obesity & Related Diseases, 2015, 11 (6): 1383-1385.
8
Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity [J]. Obesity Surgery, 2010, 20 (8): 1171-1177.
9
Lim DM, Taller J, Bertucci W, et al. Comparison of laparoscopic sleeve gastrectomy to laparoscopic Roux－en－Y gastric bypass for morbid obesity in a military institution [J]. Surgery for Obesity & Related Diseases Official Journal of the American Society for Bariatric Surgery, 1900, 10 (2): 269-276.
10
Zhang Y, Zhao H, Cao Z, et al. A randomized clinical trial of laparoscopic Roux－en－Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5－year outcome [J]. Obesity Surgery, 2014, 24 (10): 1617-1624.
11
Zhang Y, Wang J, Sun X, et al. Erratum to: laparoscopic sleeve gastrectomy versus laparoscopic Roux－En－Y gastric bypass for morbid obesity and related comorbidities: a meta－analysis of 21 studies [J]. Obesity Surgery, 2015, 25 (1): 19-26.
12
Ralph P, Yves B, Beatrice K, et al. Early results of the swiss multicentre bypass or sleeve study (SM－BOSS) [J]. Annals of Surgery, 2013, 258 (5): 690-695.
13
Reinehr T, Roth CL, Schernthaner GH, et al. Peptide yy and glucagon－like peptide－1 in morbidly obese patients before and after surgically induced weight loss [J]. Obesity Surgery, 2007, 17 (12): 1571-1577.
14
Ochner CN, Kwok Y, Conceicao E, et al. Selective reduction in neural responses to high calorie foods following gastric bypass surgery [J]. Annals of Surgery, 2011, 253 (3): 502-507.
15
Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and Peptide－YY levels after Roux－en－Y gastric bypass and sleeve gastrectomy: a prospective, double blind study [J]. Ann Surg, 2008, 247 (3): 401-407.
16
Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux－en－Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m 2 [J]. Obes Surg, 2011, 21 (11): 1650-1656.
17
Zellmer JD, Mathiason MA, Kallies KJ, et al. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux－en－Y gastric bypass? a meta－analysis [J]. Am J Surg, 2014, 208 (6): 903-910.
[1] 韩莹, 齐向秀, 刘丽娜. Roux-en-Y胃旁路术与袖状胃切除术治疗反复肥胖型急性高脂血症性胰腺炎的临床比较[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 347-350.
[2] 杨豪俊, 焦宇文, 刘寒旸, 林煌, 钱峻. 腹腔镜袖状胃切除结合十二指肠空肠吻合术治疗肥胖并非酒精性脂肪性肝病的可行性及安全性分析[J]. 中华普外科手术学杂志(电子版), 2020, 14(05): 472-475.
[3] 朱信强, 单晓东, 马济雷, 黄海龙, 蒋学通, 吴建强, 孙喜太. 两种代谢手术治疗肥胖型2型糖尿病的对比分析[J]. 中华普外科手术学杂志(电子版), 2020, 14(05): 476-479.
[4] 李雄广, 王鑫鑫, 宋奇赢, 李硕, 吴迪. 腹腔镜Roux-en-Y胃旁路术的研究现状[J]. 中华腔镜外科杂志(电子版), 2021, 14(01): 58-60.
[5] 李乐, 曲伟, 张宇红, 肖飞, 朱志军. 合并肥胖肝移植患者减重手术策略[J]. 中华肝脏外科手术学电子杂志, 2020, 09(06): 515-518.
[6] 陈俊航, 孙龙昊, 陈岩, 梁晓宇. 腹腔镜胃袖状切除术后并发Wernicke脑病1例[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 64-66.
[7] 杨华, 陈缘, 董志勇, 程中, 戴晓江, 胡扬喜, 姜涛, 梁辉, 刘金钢, 刘雁军, 马驰野, 孟化, 汪泳, 王勇, 吴良平, 杨雁灵, 姚琪远, 张能维, 张鹏, 张频, 张松海, 张忠涛, 赵象文, 朱江帆, 朱晒红, 王存川, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库：2020年度报告[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 1-7.
[8] 赵磊, 吕晗, 刘洋, 李梦伊, 孙婧, 刘佳, 赵鹏飞, 杨正汉, 张鹏, 张忠涛, 王振常. 减重代谢手术患者腹部脂肪分布与阻塞性睡眠呼吸暂停的相关性研究[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 13-18.
[9] 延冰, 孙少川. 减重代谢手术并发症单中心总结[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 19-23.
[10] 胡艳兴, 郑美华, 赵象文, 林俊, 周霞, 欧敏仪. MedioLabs随访系统在减重代谢手术患者全程管理中的应用[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 47-52.
[11] 张雯, 陈希, 王存川, 陈伟菊, 杨华, 中国肥胖代谢外科研究协作组. 肥胖代谢外科手术污名化：歧视与偏见[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 53-56.
[12] 郭婕, 杨华, 陈缘, 王存川, 中国肥胖代谢外科研究协作组. 小肠长度测量在肥胖代谢外科的应用[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 57-59.
[13] 王琰, 卫丹丹, 储勤军. 肥胖性心肌病患者减重手术麻醉管理1例[J]. 中华肥胖与代谢病电子杂志, 2020, 06(04): 265-267.
[14] 方志豪, 刘长旭, 刘昶. 腹腔镜袖状胃切除术术后并发胃梗阻修正手术1例[J]. 中华肥胖与代谢病电子杂志, 2020, 06(04): 272-275.
[15] 陈逸斐, 何安东, 李雅兰. 合并OSAHS、重度PH的病态肥胖Prader-Willi综合征患儿腹腔镜减重手术麻醉管理1例[J]. 中华肥胖与代谢病电子杂志, 2020, 06(04): 276-280.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号