腹腔镜袖状胃切除术治疗青少年肥胖症的临床疗效

Clinical efficacy of laparoscopic sleeve gastrectomy in obese adolescents

    摘要
  • 摘要:
    目的 探讨腹腔镜袖状胃切除术治疗青少年肥胖症的临床疗效。
    方法 采用回顾性描述性研究方法。收集2016年7月至2020年8月南京大学医学院附属鼓楼医院收治的37例青少年肥胖症患者的临床资料；男18例,女19例；年龄为18（13~19）岁。患者均行腹腔镜袖状胃切除术。观察指标：（1）手术及术后情况。（2）随访情况。采用门诊复查方式进行随访,了解患者术后3、6、12个月体质量、血糖、血脂、血压、营养及相关并发症情况。随访时间截至2021年8月。正态分布的计量资料以x±s表示。重复测量数据采用Repeated Measures Anova分析。偏态分布的计量资料以M（范围）表示。计数资料以绝对数或百分比表示。
    结果 （1）手术及术后情况。37例患者均顺利施行腹腔镜袖状胃切除术,手术时间为（50±7）min,术中出血量为（53±17）mL,术后住院时间为（3.0±0.5）d。37例患者中,2例出现穿刺孔感染,均未发生术后出血、切缘漏等并发症。（2）随访情况。术后3、6、12个月获得随访患者分别为35、31、22例。随访期间,患者均未出现贫血、营养不良、微量元素缺乏等营养相关并发症,无死亡患者。37例患者术前和术后12个月的体质量、体质量指数、稳态模型胰岛素抵抗指数、 甘油三酯、血清总胆固醇、收缩压、舒张压、维生素D、叶酸分别由（117±19）kg、（40±5）kg/m2、6.59（2.84~28.02）、（1.6±0.7）mmol/L、（4.5±0.7）mmol/L、（141±22）mmHg（1 mmHg=0.133 kPa）、（84±18）mmHg、（14±5）μg/L、（10±5）μg/L变为（81±15）kg、（27±4）kg/m2、2.69（1.08~9.71）、（0.9±0.5）mmol/L、（4.5±0.7）mmol/L、（115±15）mmHg、（70±11）mmHg、（23±10）μg/L、（9±5）μg/L,上述指标时间效应比较,差异均有统计学意义（F时间=214.14,160.37,12.66,11.77,2.90,18.08,11.32,8.61,5.04,P<0.05）。37例患者术后3、6、12个月多余体质量指数减少百分比分别为48%±19%、77%±28%、89%±24%,多余体质量减少百分比分别为42%±13%、63%±17%、75%±18%,全体质量减少百分比分别为18%±5%、26%±6%、34%±7%,上述指标时间效应比较,差异均有统计学意义（F时间=83.96,107.24,109.06,P<0.05）。37例患者中,2例合并2型糖尿病患者术后3、6、12个月糖化血红蛋白分别为4.8%、5.0%、5.1%和4.9%、5.2%、5.2%,2型糖尿病均缓解,无需降糖药物治疗。
    结论 腹腔镜袖状胃切除术治疗青少年肥胖症短期临床疗效确切,可有效减少青少年肥胖症患者多余体质量,改善胰岛素抵抗、血脂异常、高血压代谢合并征。

     

    Abstract:
    Objective To investigate the clinical efficacy of laparoscopic sleeve gastrectomy in obese adolescents.
    Methods The retrospective and descriptive study was conducted. The clinical data of 37 obese adolescents who were admitted to Drum Tower Hospital Affiliated to Nanjing University Medical School between July 2016 and August 2020 were collected. There were 18 males and 19 females, aged 18(range, 13‒19)years. All patients underwent laparoscopic sleeve gastrec-tomy. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. The patients were followed up by outpatient review to detect body weight, blood glucose, blood lipid, blood pressure, nutrition situation and related complications at 3, 6 and 12 months after operation. The follow-up was up to August 2021. Measurement data with normal distribution were represented as Mean±SD. Repeated measurement data were analyzed by Repeated Measures Anova. Measurement data with skewed distribution were represented by M(range). Count data were expressed as absolute numbers or percentages.
    Results (1) Surgical and postoperative situations. All 37 patients under-went laparoscopic sleeve gastrectomy successfully, the operative time was (50±7)minutes, the volume of intraoperative blood loss was (53±17)mL, and the duration of postoperative hospital stay was (3.0±0.5)days. Of the 37 patients, 2 cases had puncture infection. There was no complication such as bleeding occurred. (2) Follow-up. Of the 37 patients, 35, 31 and 22 cases were followed up at postoperative 3, 6 and 12 months, respectively. There was no anemia, malnutrition, trace element deficiency or other nutrition-related complications during the follow-up, and there was no death. The body mass, body mass index, homeostasis model assessment-insulin resistance, triglyceride, total cholesterol, systolic pressure, diastolic pressure, vitamin D, folate of the 37 patients were (117±19)kg, (40±5)kg/m2, 6.59(range, 2.84‒28.02), (1.6±0.7)mmol/L, (4.5±0.7)mmol/L, (141±22)mmHg (1 mmHg=0.133 kpa), (84±18)mmHg,(14±5)μg/L, (10±5)μg/L before the surgery, and (81±15)kg, (27±4)kg/m2, 2.69(range, 1.08‒9.71), (0.9±0.5)mmol/L, (4.5±0.7)mmol/L, (115±15)mmHg, (70±11)mmHg, (23±10)μg/L, (9±5)μg/L at postoperative 12 months. There were significant differences in the time effect of above indicators (Ftime=214.14, 160.37, 12.66, 11.77, 2.90, 18.08, 11.32, 8.61, 5.04, P<0.05). The percentages of excess of body mass index lost of the 37 patients were 48%±19%, 77%±28% and 89%±24% at postoperative 3, 6 and 12 months, the percentages of excess weight loss were 42%±13%, 63%±17% and 75%±18%, the percentages of total body weight loss were 18%±5%, 26%±6% and 34%±7%, respectively. There were significant differences in the time effect of above indicators (Ftime=83.96, 107.24, 109.06, P<0.05). The hemoglobin A1c was 4.8%, 5.0%, 5.1% and 4.9%, 5.2%, 5.2% in the 2 patients with type 2 diabetes at postoperative 3, 6 and 12 months, respectively, and they were relieved without drug treatment.
    Conclusion Laparoscopic sleeve gastrectomy has definite short-term clinical efficacy in the treatment of adolescent obesity, which can effectively reduce excess body weight and improve the metabolic complications of insulin resis-tance, dyslipidemia and hypertension.

     

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