中国实用外科杂志

中国实用外科杂志

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术前体重对腹腔镜胃袖状切除术后临床疗效影响研究

张    鹏1，陈丽华2，王廷峰2，伍    雯2，章    雄2，田沛荣1，张忠涛1   

  1. 1首都医科大学附属北京友谊医院普外科中心减重与代谢外科  国家消化系统疾病临床医学研究中心，北京 100050；2复旦大学附属浦东医院糖尿病与肥胖外科，上海 200139
  • 出版日期:2021-07-01 发布日期:2021-07-12

  • Online:2021-07-01 Published:2021-07-12

摘要： 目的    比较腹腔镜胃袖状切除术（laparoscopic sleeve gastrectomy，LSG）治疗高BMI与低BMI肥胖症合并代谢紊乱病人的临床疗效。方法    回顾性分析2013—2018年复旦大学附属浦东医院收治的因肥胖症或肥胖合并2型糖尿病（T2DM）等代谢紊乱而接受LSG的113例病人的临床资料，按术前BMI值将病人分为低BMI组（BMI≤35，38例）和高BMI组（BMI>35，75例），术后1、3、6和12个月进行随访，比较两组病人体重、血糖代谢、血脂和血压等相关指标的改善情况。结果    LSG术后高BMI组较低BMI组体重下降更为明显，12个月时，平均总体重减轻百分比（%TWL）分别为32.6%和26.1%（P<0.001），低BMI组的平均BMI降至23.3，而高BMI组则为28.3（P<0.001）。术后，高BMI组比低BMI组有更多病人的空腹血糖（FPG）和糖化血红蛋白A1c（HbA1c）下降至理想水平，两组在术前和术后12个月时，FPG>7 mmol/L的病例数占比分别为33.3%和2.7%、44.7%和15.8%（P均<0.05），HbA1c > 6.5%的病例数占比分别为48.0%和57.9%、2.7%和26.3% （P均<0.05）。两组病人术后甘油三酯（TG）和低密度脂蛋白胆固醇（LDL-c）水平下降以及血压变化差异无统计学意义，但低BMI组病人高密度脂蛋白胆固醇（HDL-c）的上升幅度较高BMI组更加显著（P<0.05）。结论    LSG术后，高BMI病人体重减轻更多，所合并的T2DM有更大可能获得临床缓解，但低BMI病人术后体重有较大可能降低为正常体重水平，且血脂的改善优于高BMI病人。

关键词: 腹腔镜胃袖状切除术, 肥胖症, 2型糖尿病, 高脂血症, 高血压病

Abstract: The effect of pre-operative body weight on the clinical outcome of laparospic sleeve gastrectomy        ZHANG Peng，CHEN Li-hua，WANG Ting-feng，et al. Division of Metabolic and Bariatric Surgery，Department of General Surgery，Beijing Friendship Hospital，Capital Medical University & National Clinical Research Center for Digestive Diseases，Beijing 100050，China
Corresponding author：CHEN Li-hua，E-mail：13764925567@163.com
Abstract    Objective    To compare the clinical outcome of laparoscopic sleeve gastrectomy (LSG) in the metabolic disordered patients with high body mass index (BMI) versus low BMI obesity. Methods    A total of 113 patients who underwent LSG due to obesity and metabolic disorders  in Fudan University Pudong Hospital between 2013 and 2018 were divided into low BMI (BMI ≤ 35，n=38) and high BMI groups (BMI > 35，n=75) for the retrospective analysis. The body weight related parameters，glycemic metabolic related parameters，lipid panel as well as arterial blood pressure were compared at pre-operative baseline，1，3，6，and 12 months after surgery. Results    High BMI patients had better weight loss than low BMI patients after surgery. At 12 months after surgery, percentage of total weight loss (%TWL) in high BMI and low BMI groups were 32.6% and 26.1%, respectively (P<0.001). However，mean BMI of low BMI group achieved 23.3  which was within the normal range，while high BMI group still had 28.29 (P<0.001). In addition，high BMI group had more patients achieved ideal fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels. The ratios of patients with FPG >7mmol/L pre-operatively and 12 months after LSG in high and low BMI groups were 33.3% vs 44.7% and 2.7% vs 15.8%，and the ratios of patients with HbA1c > 6.5% were 48.0% vs 57.9% and 2.7% vs 26.3%，respectively (P<0.05). Although there was not any significant difference between two groups in triglyceride (TG),  low density lipoprotein cholesterol (LDL-c)，or arterial blood pressure, the escalation of high density lipoprotein cholesterol (HDL-c) were more favorable in the low BMI group. Conclusion    Although more weight loss and higher remission rate of type 2 diabetes mellitus (T2DM) are achieved if preoperative BMI is high，the body weight in low BMI patients has a higher chance to return back to normal range. The qualities of plasma lipid panel improvements are more favorable in the low BMI patients.

Key words: laparoscopic sleeve gastrectomy, obesity, type 2 diabetes mellitus, hyperlipidemia, hypertension