腹腔镜袖状胃切除术在合并急性胆囊炎肥胖患者中的应用

doi:10.3877/cma.j.issn.1674-6899.2017.04.008

目的

探讨腹腔镜袖状胃手术(laparoscopic sleeve gastrectomy, LSG)在合并急性结石性胆囊炎的肥胖症患者中的应用价值，分析LSG联合腹腔镜胆囊切除术(laparoscopic cholecystectomy，LC)的安全性，总结手术经验。

方法

回顾性分析2015年8月至2016年11月于川北医学院附属医院肝胆外科完成的25例LC联合LSG患者的临床资料，对比术前、术后资料和围手术期相关结果。所有患者随访6个月，统计随访资料。

结果

25例患者均成功实施了LC联合LSG。均无胆瘘、胆道损伤、胃瘘、腹腔出血等明显并发症。患者体重由(88.3 ± 11.6 )kg降至(61.1 ± 10.5)kg，体重指数由34.5 ± 5.7降至23.4 ± 0.9 。其中18例合并高脂血症患者的血脂由术前(12.4 ± 8.5)mmol/L降至(2.1 ± 0.8)mmol/L，6例伴2型糖尿病患者的空腹血糖由术前(13.1 ± 1.6) mmol/L降至(5.8 ± 1.0)mmol/L，7例伴有高血压病患者的术前血压由(164 ± 14)/(102 ± 8) mmHg降至(135 ± 11.2)/(91 ± 6.9)mmHg。

结论

对急性结石性胆囊炎合并肥胖症的患者行LC联合LSG是安全可行的，其治疗胆囊疾病、减重和代谢病的疗效类似于单独的LC或LSG。在临床工作中，医师有必要对此类患者提供全面的手术选项。

关键词: 胆囊炎, 胆囊结石, 袖状胃手术, 减重, 代谢病

Objective

To investigate the application value of laparoscopic sleeve gastrectomy(LSG) in obese patients with acute calculous cholecystitis, to explore the safety of the LSG combined with laparoscopic cholecystectomy(LC), and to summarize the experience of operation.

Methods

Perioperative clinical data of 25 consecutive with LC combined with LSG procedures performed from Aug. 2015 to Nov.2016 in Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College were retrospective analyzed. Preoperative, postoperative and perioperative data were collected. All patients were followed up for 6 months, with statistical follow-up data.

Results

LC combined with LSG was successfully performed in 25 patients. There was no biliary fistula, biliary tract injury, gastric fistula, abdominal bleeding and other obvious complications. The patient′s body weight was decreased from(88.3±11.6)kg to (61.1 ± 10.5)kg, BMI decreased from 34.5 ± 5.7 to 23.4 ± 0.9. The blood lipids levels from preoperative (12.4 ± 8.5)mmol/L down to (2.1 ± 0.8)mmol/L in 18 hyperlipidemia patients; The fasting blood glucose levels from preoperative (13.1 ± 1.6) mmol / L down to (5.8 ± 1.0)mmol/L in 6 patients with type 2 diabetes; and blood pressure decreased from (164 ± 14) / (102 ± 8) mmHg to (135 ± 11.2 )/ (91 ± 6.9)mmHg in 7 patients with hypertension.

Conclusions

The LC combined with LSG is a safe and feasible operation for patients with acute calculous cholecystitis and obesity. The therapeutic effect of gallbladder disease, weight loss and metabolic disease is similar to that of LC or LSG alone. In clinical practice, doctors need to provide a comprehensive surgical options for such patients.

Key words: Cholecystitis, Gallstones, Sleeve gastrectomy, Weight loss, Metabolic disease

表1 急性结石性胆囊炎合并肥胖症患者的术前、术后相关指标变化情况比较(±s)

项目	例数	体重(kg)	体重指数	血脂(mmol/L)	空腹血糖(mmol/L)	血压(mmHg)
术前	25	88.3±11.6	34.5±5.7	12.4±8.5	13.1±1.6	164±14/102±8
术后6个月	25	61.1±10.5	23.4±0.9	2.1±0.8	5.8±1.0	135±11/91±7
t值	?	0.913	0.901	0.845	0.772	0.637
P值	?	<0.05	<0.05	<0.05	<0.05	<0.05

表1 急性结石性胆囊炎合并肥胖症患者的术前、术后相关指标变化情况比较(±s)

项目	例数	体重(kg)	体重指数	血脂(mmol/L)	空腹血糖(mmol/L)	血压(mmHg)
术前	25	88.3±11.6	34.5±5.7	12.4±8.5	13.1±1.6	164±14/102±8
术后6个月	25	61.1±10.5	23.4±0.9	2.1±0.8	5.8±1.0	135±11/91±7
t值	?	0.913	0.901	0.845	0.772	0.637
P值	?	<0.05	<0.05	<0.05	<0.05	<0.05

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Application of sleeve gastrectomy in obese patients with acute calculous cholecystitis

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Application of sleeve gastrectomy in obese patients with acute calculous cholecystitis