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

1	Haslam DW, James WPT. Obesity: the lancet[J]. Lancet, 2005，366(9492): 1197-1209.
2	Cesare MD, Bentham J, Stevens GA, et al. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants[J]. Lancet, 2016, 387(10026): 1377-1379.
3	Arterburn DE, Courcoulas AP. State of the art review: bariatric surgery for obesity and metabolic conditions in adults[J]. Bmj British Medical Journal, 2014, 349(349): 3961.
4	张鹏，郑成竹，Alfonso ，等. 美国减重代谢外科现状及与我国异同[J]. 中国实用外科杂志，2014, 34(11): 1094-1096.
5	Carlos , Augusto , Gomes , et al. Acute calculous cholecystitis: review of current best practices[J]. World Journal of Gastrointestinal Surgery, 2017, 9(5): 118-126.
6	倪怀坤. 结石性萎缩性胆囊炎腔镜手术并发症分析[J/CD]．中华腔镜外科杂志(电子版), 2015，8(5): 17-19.
7	Ansaloni L, Pisano M, Coccolini F, et al. 2016 WSES guidelines on acute calculous cholecystitis[J]. World Journal of Emergency Surgery Wjes, 2016, 11(1): 1-23.
8	Dakour-Aridi HN, El-Rayess HM, Abou-Abbass H, et al. Safety of concomitant cholecystectomy at the time of laparoscopic sleeve gastrectomy: analysis of the ACS-NSQIP database[J]．Surg Obes Relat Dis. 2017，13(6): 942.
9	Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013[J]. Obesity Surgery, 2015, 25(10): 1822-1832.
10	Pories WJ, Swanson MS, Macdonald KG, et al. Who would have thought it? an operation proves to be the most effective therapy for adult-onset diabetes mellitus[J]. Annals of Surgery, 1995, 222(3): 339-350.
11	康维明，马志强，于健春. 肥胖症减重手术术式及其相关问题[J]. 中国医学科学院学报，2010, 32(1): 16-19.
12	Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy[J]. Obesity Surgery, 2008, 18(10): 1323-1329.
13	Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients[J]. Obesity Surgery, 2006, 16(9): 1138-1144.
14	Festi D, Dormi A, Capodicasa S, et al. Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project)[J]. World Journal of Gastroenterology, 2008, 14(34): 5282-5289.
15	Magouliotis DE, Tasiopoulou VS, Svokos AA, et al. One-anastomosis gastric bypass versus sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis[J]. Obesity Surgery, 2017，27(9): 2479-2487.
16	Puzziferri N, Rd RT, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review[J]. Jama, 2014, 312(9): 934-942.
17	Oberbach A, Neuhaus J, Inge T, et al. Bariatric surgery in severely obese adolescents improves major comorbidities including hyperuricemia[J]. Metabolism Clinical Experimental, 2014, 63(2): 242-249.
18	Romero-Talamás H, Daigle CR, Aminian A, et al. The effect of bariatric surgery on gout: a comparative study[J]. Surgery for Obesity & Related Diseases, 2014, 10(6): 1161-1165.
19	Golomb I, Ben DM, Glass A, et al. Long-term metabolic effects of laparoscopic sleeve gastrectomy[J]. Jama Surgery, 2015, 150(11): 1051-1057.
20	Brito JP, Montori VM, Davis AM.Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations[J]．Diabetes Care, 2016, 12(6): 1-20.
21	吴溢，李敬东，祝顺萍，等．青少年肥胖症的危害和治疗现状[J/CD]. 中华肥胖与代谢病电子杂志，2017，3(2): 70-73.

[1]	邵得志, 冯志毅, 郭乃超, 吕衍霖, 王晓翠, 董宇豪. 急性非结石性胆囊炎42例诊治分析[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 434-436.
[2]	邸亮, 郭庆良, 赵晓飞, 丁兢, 段斌炜. 双镜联合治疗腹部手术史胆囊并胆总管结石的近期随访分析[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 440-443.
[3]	张娟, 张艳芳, 马静, 杨雷, 吴华彰, 李灵艳, 叶枫林. ERAS对胆囊结石合并胆总管结石患者术后康复及应激因子的影响[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 444-446.
[4]	尚培中, 李晓武, 苗建军, 刘冰. 腹腔镜治疗胆囊结石预防胆管损伤的两种安全策略[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 255-258.
[5]	彭正, 陈之强, 杨琦, 段斌炜. 双镜联合同期手术治疗老年胆囊结石并胆总管结石的疗效[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 335-338.
[6]	张乾, 肖瑞, 杨景瑞, 周江, 王家兴, 刘少杰, 张小冬, 任建军. 腹腔镜下胆道探查取石T管引流优化术的临床应用[J]. 中华普外科手术学杂志(电子版), 2021, 15(02): 211-214.
[7]	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.
[8]	杨振宇, 段东峰, 杜锡林, 孙涛, 包国强, 何显力. 放射性核素肝胆显像和超声在保胆手术患者中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 464-469.
[9]	丁天龙, 谷保红, 李雪梅, 胡继科, 张凡, 冯泽东, 马斌, 王琛, 陈昊. "脱衣法"腹腔镜胆囊切除术的应用[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 498-501.
[10]	王伟龙, 温子龙, 郑宗敏, 朱文峰, 郑强, 薛平. ERCP+LC与LCBDE+LC治疗胆囊结石合并胆总管结石疗效对比研究[J]. 中华肝脏外科手术学电子杂志, 2021, 10(02): 158-164.
[11]	刘卓, 张宗明, 林方才, 刘立民, 张翀, 万柏江, 朱明文, 赵月, 邓海. 新型冠状病毒肺炎疫情防控期间急性梗阻性化脓性胆管炎一例诊治体会[J]. 中华重症医学电子杂志, 2021, 07(01): 84-87.
[12]	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.
[13]	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.
[14]	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.
[15]	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.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Application of sleeve gastrectomy in obese patients with acute calculous cholecystitis

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Application of sleeve gastrectomy in obese patients with acute calculous cholecystitis