發(fā)布時(shí)間：2018-08-18 09:01

【摘要】：背景：病態(tài)肥胖癥(Morbid Obesity, MO)已成為世界范圍內(nèi)流行的一種慢性疾病。減重手術(shù)目前被認(rèn)為是緩解MO最為有效的治療方式。其中以腹腔鏡袖狀胃切除術(shù)(Laparoscopic Sleeve Gastrectomy, LSG)應(yīng)用較為廣泛。LSG初期只應(yīng)用于MO患者行Roux-en-Y胃旁路術(shù)(Roux-en-Y Gastric Bypass,RYGB)第一階段的外科治療。近年來(lái)研究表明,LSG術(shù)后不僅有效而持久地降低體重,同時(shí)可以顯著改善2型糖尿病、高血壓及血脂異常等肥胖相關(guān)疾病。目前,LSG已經(jīng)逐漸成為一種獨(dú)立的減重手術(shù)。因其手術(shù)操作相對(duì)簡(jiǎn)便,療效確切持久而受到廣泛認(rèn)可。本研究總結(jié)了自2006年12月至2014年11月期間于我科行LSG共5例MO患者的臨床資料,通過(guò)對(duì)比MO患者LSG術(shù)前、術(shù)后體重變化以及伴隨疾病的緩解情況,進(jìn)一步探討LSG的臨床應(yīng)用及療效分析。目的：觀察MO患者行LSG前后的體重、BMI、腰圍、臀圍及腰臀比等指標(biāo)變化、術(shù)后并發(fā)癥及伴隨疾病緩解情況,并以此評(píng)價(jià)LSG的可行性、安全性及其療效。同時(shí)對(duì)于LSG的技術(shù)要點(diǎn)進(jìn)行討論。方法：回顧性分析2006年12月至2014年11月期間于我科接受LSG的5例MO患者的臨床資料。其中MO合并脂肪肝3例,MO合并2型糖尿病1例,MO合并睡眠呼吸暫停綜合征2例,男性2例,女性3例,年齡(30.2±7.6)歲,體重(141.4±29.1)kg,身高(169.2±8.9)cm,BMI(49.2±9.0)kg/m2,腰圍(136.8±25.5)cm,臀圍(144.8±15.9)cm,腰臀比(0.95±0.17)�；颊呷朐汉笮邢到y(tǒng)檢查,均排除繼發(fā)性肥胖。排除手術(shù)禁忌后在靜吸復(fù)合氣管插管全麻下行LSG。出院后隨訪患者體重變化及伴隨疾病緩解情況。各組數(shù)據(jù)應(yīng)用SPSS 20.0軟件進(jìn)行統(tǒng)計(jì)分析,均以平均數(shù)±標(biāo)準(zhǔn)差表示,P0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果：5例LSG全部獲得成功,無(wú)中轉(zhuǎn)開(kāi)腹及死亡病例。手術(shù)時(shí)間為(204.0±51.4)min,術(shù)中出血量為(39.4±16.3)ml,術(shù)后胃腸道功能恢復(fù)時(shí)間為(1.6±0.5)d,術(shù)后住院時(shí)間為(7.6±2.2)d。術(shù)后2例患者轉(zhuǎn)入ICU,應(yīng)用呼吸機(jī)輔助通氣,均成功脫機(jī)并拔除氣管插管后轉(zhuǎn)回我科。術(shù)后均未見(jiàn)吻合口出血、胃瘺、胃癱及切口感染等圍手術(shù)期并發(fā)癥。無(wú)死亡病例。術(shù)后隨訪3-8個(gè)月,患者恢復(fù)良好,體重等指標(biāo)變化如下：術(shù)后1個(gè)月,體重為(126.8±25.2)kg (P=0.42 0.05),BMI為(44.1±7.4)kg/m2(P=0.360.05)；術(shù)后3個(gè)月,體重為(111.6 ±20.8)kg(P=0.100.05),BMI為(39.0±7.1)kg/m2(P=0.080.05)；術(shù)后6個(gè)月,體重為(96.8±14.5)kg(P=0.0150.05),BMI為(33.8±5.0)kg/m2(P=0.010.05)�；颊逿2DM、脂肪肝及阻塞性睡眠呼吸暫停綜合癥等伴隨疾病均得到不同程度的改善。結(jié)論：腹腔鏡袖狀胃切除術(shù)(LSG)治療MO的安全性及可行性較高,療效肯定,并且對(duì)于相關(guān)伴隨疾病如2型糖尿病、OSAS等均具有一定的緩解率。LSG手術(shù)操作較其他減重手術(shù)相對(duì)簡(jiǎn)便,易被患者所接受,可以在臨床大規(guī)模開(kāi)展。由于本研究病例樣本數(shù)量較少,有待于大樣本病例研究進(jìn)一步證實(shí)。
[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 鹵7.6) years old, the weight was (141.4 鹵29.1) kg, the height was (169.2 鹵8.9) cm 路m ~ (2), the waist circumference was (136.8 鹵25.5) cm, the hip circumference was (144.8 鹵15.9) cm, the waist-to-hip ratio was (0.95 鹵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 鹵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 鹵51.4) min, the intraoperative bleeding was (39.4 鹵16.3) ml, the postoperative gastrointestinal function recovery time was (1.6 鹵0.5) d, and the postoperative hospitalization time was (7.6 鹵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 鹵25.2) kg () kg/m2 (P < 0.05), 3 months after operation, the body mass index was (111.6 鹵20.8) kg () kg/m2 (39.0 鹵7.1) kg/m2 (P0.080.05), and the body weight was (96.8 鹵14.5) kg (P0.0150.05) kg/m2 (33.8 鹵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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R656.6

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