腹腔镜 Roux-en-Y 胃旁路术与腹腔镜胃袖状切除术治疗肥胖病的对比研究

摘要

目的比较腹腔镜Roux-en-Y胃旁路术（laparoscopic Roux-en-Y gastric bypass，LRYGB）与腹腔镜胃袖状切除术（ laparoscopic sleeve gastrectomy ，LSG）治疗肥胖病的疗效。方法2012年1月～2014年1月符合入组条件的肥胖病49例，术前BMI 38．85±6．40（32．01～58．64），其中42例（86％）合并2型糖尿病，37例（76％）合并高甘油三酯血症（hypertriglyceridemia，HTG）。根据患者选择的手术方式分为LRYGB组（n＝26）和LSG组（n＝23），将临床资料进行对比研究。结果2组均成功实施手术。 LRYGB组手术时间明显长于LSG组[（108．8±16．1） min vs．（90．9±24．8） min，t＝3.031，P＝0．004]。术后随访12～28个月，平均16个月。49例术后12个月BMI 29．75±3．46，与术前相比明显下降（ t＝14.135，P＝0.000）；术后多余体重减除率（EWL％）80．06％±14．28％（51．00％～120．00％）。42例合并2型糖尿病者术后空腹血糖和糖化血红蛋白较术前明显下降[（9．23±3．40） mmol／L vs．（8．00±1．94） mmol／L，t ＝3．168，P＝0．003；6．22％±1.63％vs．5.43％±0．93％，t＝7．212，P＝0．000]；37例合并HTG患者术后甘油三酯水平较术前亦下降[（2．49±0．77） mmol／L vs．（1.64±0．68）mmol／L，t＝5．202，P＝0．000]。2组体重减轻、降糖、降脂效果无明显差异（P均＞0．05）。结论LRYGB与LSG治疗肥胖病是安全有效的，对合并2型糖尿病及高甘油三酯血症也有较好的疗效。 LSG操作相对简单，符合胃肠道生理，值得优先选择。%Objective To compare the effects of laparoscopic Roux-en-Y gastric bypass ( LRYGB) and laparoscopic sleeve gastrectomy ( LSG) for the treatment of the obesity patients . Methods A total of 49 patients suffering from severe obesity were enrolled in this study in our hospital from January 2012 to January 2014.The mean body mass index ( BMI) ranged 32.01-58.64 (38.85 ±6.40) before surgery.Among them, 42 (86%) patients had type 2 diabetes (DM2) and 37 (76%) patients had hypertriglyceridemia ( HTG) .The patients were divided into LRYGB group ( n =26 ) or LSG group ( n=23 ) based on patients ’ selection.Clinical data of the two group were compared . Results All the patients underwent surgery successfully .The average operating time in the LRYGB group was significantly longer than the LSG group [(108.8 ±16.1) min vs.(90.9 ±24.8) min, t=3.031, P=0.004)].The patients were followed up for 12-28 months, with an average period of 16 months.The BMI of all the patients was 29.75 ±3.46 at 12 months after surgery , which was decreased significantly than before the surgery ( t=14.135, P=0.000).The mean excess weight loss (EWL%) was 80.06%±14.28% (51.00%-120.00%) at 12 months after surgery.The average levels of fasting blood sugar (FBS) and glycosylated hemoglobin (HbAlc) after surgery in 42 obesity patients with DM2 were lower than those before surgery [(9.23 ±3.40) mmol/L vs.(8.00 ±1.94) mmol/L, t=3.168, P=0.003;6.22%±1.63% vs. 5.43%±0.93%, t=7.212, P=0.000].The mean serum triglyceridein in 37 obesity patients with HTG was decreased after surgery as compared to that before surgery [(2.49 ±0.77) mmol/L vs.(1.64 ±0.68) mmol/L, t=5.202, P=0.000].There were no significant difference in the body weight loss , decrease of fasting blood sugar and serum triglyceride between the two groups ( P>0.05). Conclusions LRYGB and LSG are safe and effective to treat the patients suffered from obesity , including patients with type 2 diabetes or hypertriglyceridemia .We recommend LSG as preferable choice of the surgical procedure considering simple performance as well as no change of digestive system .