腹腔镜袖状胃切除术治疗病态肥胖症的临床应用研究
发布时间：2018-08-18 09:01
【摘要】：背景：病态肥胖症(Morbid Obesity, MO)已成为世界范围内流行的一种慢性疾病。减重手术目前被认为是缓解MO最为有效的治疗方式。其中以腹腔镜袖状胃切除术(Laparoscopic Sleeve Gastrectomy, LSG)应用较为广泛。LSG初期只应用于MO患者行Roux-en-Y胃旁路术(Roux-en-Y Gastric Bypass,RYGB)第一阶段的外科治疗。近年来研究表明,LSG术后不仅有效而持久地降低体重,同时可以显著改善2型糖尿病、高血压及血脂异常等肥胖相关疾病。目前,LSG已经逐渐成为一种独立的减重手术。因其手术操作相对简便,疗效确切持久而受到广泛认可。本研究总结了自2006年12月至2014年11月期间于我科行LSG共5例MO患者的临床资料,通过对比MO患者LSG术前、术后体重变化以及伴随疾病的缓解情况,进一步探讨LSG的临床应用及疗效分析。目的：观察MO患者行LSG前后的体重、BMI、腰围、臀围及腰臀比等指标变化、术后并发症及伴随疾病缓解情况,并以此评价LSG的可行性、安全性及其疗效。同时对于LSG的技术要点进行讨论。方法：回顾性分析2006年12月至2014年11月期间于我科接受LSG的5例MO患者的临床资料。其中MO合并脂肪肝3例,MO合并2型糖尿病1例,MO合并睡眠呼吸暂停综合征2例,男性2例,女性3例,年龄(30.2±7.6)岁,体重(141.4±29.1)kg,身高(169.2±8.9)cm,BMI(49.2±9.0)kg/m2,腰围(136.8±25.5)cm,臀围(144.8±15.9)cm,腰臀比(0.95±0.17)。患者入院后行系统检查,均排除继发性肥胖。排除手术禁忌后在静吸复合气管插管全麻下行LSG。出院后随访患者体重变化及伴随疾病缓解情况。各组数据应用SPSS 20.0软件进行统计分析,均以平均数±标准差表示,P0.05有统计学意义。结果：5例LSG全部获得成功,无中转开腹及死亡病例。手术时间为(204.0±51.4)min,术中出血量为(39.4±16.3)ml,术后胃肠道功能恢复时间为(1.6±0.5)d,术后住院时间为(7.6±2.2)d。术后2例患者转入ICU,应用呼吸机辅助通气,均成功脱机并拔除气管插管后转回我科。术后均未见吻合口出血、胃瘘、胃瘫及切口感染等围手术期并发症。无死亡病例。术后随访3-8个月,患者恢复良好,体重等指标变化如下：术后1个月,体重为(126.8±25.2)kg (P=0.42 0.05),BMI为(44.1±7.4)kg/m2(P=0.360.05)；术后3个月,体重为(111.6 ±20.8)kg(P=0.100.05),BMI为(39.0±7.1)kg/m2(P=0.080.05)；术后6个月,体重为(96.8±14.5)kg(P=0.0150.05),BMI为(33.8±5.0)kg/m2(P=0.010.05)。患者T2DM、脂肪肝及阻塞性睡眠呼吸暂停综合症等伴随疾病均得到不同程度的改善。结论：腹腔镜袖状胃切除术(LSG)治疗MO的安全性及可行性较高,疗效肯定,并且对于相关伴随疾病如2型糖尿病、OSAS等均具有一定的缓解率。LSG手术操作较其他减重手术相对简便,易被患者所接受,可以在临床大规模开展。由于本研究病例样本数量较少,有待于大样本病例研究进一步证实。
[Abstract]:Background: morbid obesity (Morbid Obesity, MO) has become a chronic disease worldwide. Weight loss surgery is currently considered to be the most effective treatment for MO. Among them, laparoscopic sleeve gastrectomy (Laparoscopic Sleeve Gastrectomy, LSG) was widely used. LSG was only used in the first stage of Roux-en-Y Gastric gastric bypass surgery (Roux-en-Y Gastric Bypassa GYGB) in patients with MO at the initial stage. Recent studies have shown that LSG not only can effectively and persistently reduce body weight, but also can significantly improve obesity related diseases such as type 2 diabetes, hypertension and dyslipidemia. At present, LSG has gradually become an independent weight loss surgery. Its operation is relatively simple, the curative effect is exact and lasting, so it is widely accepted. This study summarized the clinical data of 5 patients with MO who received LSG from December 2006 to November 2014, and compared the changes of body weight and the remission of associated diseases before and after LSG in MO patients. To further explore the clinical application and curative effect analysis of LSG. Objective: to observe the changes of body weight, waist circumference, hip circumference and waist-to-hip ratio, postoperative complications and associated disease remission in MO patients before and after LSG, and to evaluate the feasibility, safety and efficacy of LSG. At the same time, the technical points of LSG are discussed. Methods: the clinical data of 5 MO patients who received LSG from December 2006 to November 2014 were analyzed retrospectively. There were 3 cases of MO with fatty liver combined with type 2 diabetes mellitus, 2 cases of MO with sleep apnea syndrome, 2 cases of male and 3 cases of female. The age was (30.2 卤7.6) years old, the weight was (141.4 卤29.1) kg, the height was (169.2 卤8.9) cm 路m ~ (2), the waist circumference was (136.8 卤25.5) cm, the hip circumference was (144.8 卤15.9) cm, the waist-to-hip ratio was (0.95 卤0.17). The patients underwent systematic examination after admission and were excluded from secondary obesity. After removing operative taboos, LSG was performed under general anesthesia with intravenous inhalation combined with tracheal intubation. The changes of body weight and the remission of associated diseases were followed up after discharge. The data of each group were statistically analyzed by SPSS 20.0 software. The mean 卤standard deviation (P 0.05) was statistically significant. Results all of the 5 cases of LSG were successful, and there were no cases of conversion to laparotomy or death. The operative time was (204.0 卤51.4) min, the intraoperative bleeding was (39.4 卤16.3) ml, the postoperative gastrointestinal function recovery time was (1.6 卤0.5) d, and the postoperative hospitalization time was (7.6 卤2.2) d. After operation, 2 patients were transferred to ICU, ventilator assisted ventilation. All patients were successfully weaned and tracheal intubation was removed and transferred back to our department. There were no perioperative complications such as anastomotic bleeding, gastric fistula, gastroparesis and incision infection. There were no deaths. After 3 to 8 months follow-up, the patients recovered well and their body weight changed as follows: 1 month after operation, the body weight was (126.8 卤25.2) kg () kg/m2 (P < 0.05), 3 months after operation, the body mass index was (111.6 卤20.8) kg () kg/m2 (39.0 卤7.1) kg/m2 (P0.080.05), and the body weight was (96.8 卤14.5) kg (P0.0150.05) kg/m2 (33.8 卤5.0) kg/m2 (P0.010.05). Patients with T 2 DM, fatty liver, obstructive sleep apnea syndrome and other associated diseases were improved to varying degrees. Conclusion: laparoscopic sleeve gastrectomy (LSG) is safe, feasible and effective in the treatment of MO, and has a certain remission rate for associated diseases such as type 2 diabetes mellitus. LSG operation is relatively simple than other weight-loss surgery. Easily accepted by patients, can be carried out on a large scale in clinical practice. Due to the small number of cases in this study, the large sample case study needs to be further confirmed.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.6
本文编号：2188998
[Abstract]:Background: morbid obesity (Morbid Obesity, MO) has become a chronic disease worldwide. Weight loss surgery is currently considered to be the most effective treatment for MO. Among them, laparoscopic sleeve gastrectomy (Laparoscopic Sleeve Gastrectomy, LSG) was widely used. LSG was only used in the first stage of Roux-en-Y Gastric gastric bypass surgery (Roux-en-Y Gastric Bypassa GYGB) in patients with MO at the initial stage. Recent studies have shown that LSG not only can effectively and persistently reduce body weight, but also can significantly improve obesity related diseases such as type 2 diabetes, hypertension and dyslipidemia. At present, LSG has gradually become an independent weight loss surgery. Its operation is relatively simple, the curative effect is exact and lasting, so it is widely accepted. This study summarized the clinical data of 5 patients with MO who received LSG from December 2006 to November 2014, and compared the changes of body weight and the remission of associated diseases before and after LSG in MO patients. To further explore the clinical application and curative effect analysis of LSG. Objective: to observe the changes of body weight, waist circumference, hip circumference and waist-to-hip ratio, postoperative complications and associated disease remission in MO patients before and after LSG, and to evaluate the feasibility, safety and efficacy of LSG. At the same time, the technical points of LSG are discussed. Methods: the clinical data of 5 MO patients who received LSG from December 2006 to November 2014 were analyzed retrospectively. There were 3 cases of MO with fatty liver combined with type 2 diabetes mellitus, 2 cases of MO with sleep apnea syndrome, 2 cases of male and 3 cases of female. The age was (30.2 卤7.6) years old, the weight was (141.4 卤29.1) kg, the height was (169.2 卤8.9) cm 路m ~ (2), the waist circumference was (136.8 卤25.5) cm, the hip circumference was (144.8 卤15.9) cm, the waist-to-hip ratio was (0.95 卤0.17). The patients underwent systematic examination after admission and were excluded from secondary obesity. After removing operative taboos, LSG was performed under general anesthesia with intravenous inhalation combined with tracheal intubation. The changes of body weight and the remission of associated diseases were followed up after discharge. The data of each group were statistically analyzed by SPSS 20.0 software. The mean 卤standard deviation (P 0.05) was statistically significant. Results all of the 5 cases of LSG were successful, and there were no cases of conversion to laparotomy or death. The operative time was (204.0 卤51.4) min, the intraoperative bleeding was (39.4 卤16.3) ml, the postoperative gastrointestinal function recovery time was (1.6 卤0.5) d, and the postoperative hospitalization time was (7.6 卤2.2) d. After operation, 2 patients were transferred to ICU, ventilator assisted ventilation. All patients were successfully weaned and tracheal intubation was removed and transferred back to our department. There were no perioperative complications such as anastomotic bleeding, gastric fistula, gastroparesis and incision infection. There were no deaths. After 3 to 8 months follow-up, the patients recovered well and their body weight changed as follows: 1 month after operation, the body weight was (126.8 卤25.2) kg () kg/m2 (P < 0.05), 3 months after operation, the body mass index was (111.6 卤20.8) kg () kg/m2 (39.0 卤7.1) kg/m2 (P0.080.05), and the body weight was (96.8 卤14.5) kg (P0.0150.05) kg/m2 (33.8 卤5.0) kg/m2 (P0.010.05). Patients with T 2 DM, fatty liver, obstructive sleep apnea syndrome and other associated diseases were improved to varying degrees. Conclusion: laparoscopic sleeve gastrectomy (LSG) is safe, feasible and effective in the treatment of MO, and has a certain remission rate for associated diseases such as type 2 diabetes mellitus. LSG operation is relatively simple than other weight-loss surgery. Easily accepted by patients, can be carried out on a large scale in clinical practice. Due to the small number of cases in this study, the large sample case study needs to be further confirmed.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.6
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