腹腔镜可调节胃束带折叠术治疗肥胖疗效观察

Therapeutic effect of laparoscopic adjustable gastric banding for obesity

  • 摘要: 目的 观察腹腔镜可调节胃束带折叠术(laparoscopic adjustable gastric banding,LAGB)治疗肥胖和肥胖伴发的2型糖尿病(type 2 diabetes,T2DM)的疗效与安全性。 方法 选取2012年4月-2014年4月在解放军总医院接受LAGBP 32例与腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)肥胖患者34例,其中LAGBP组有9例肥胖合并2型糖尿病,LSG组有11例肥胖合并T2DM。比较两组人体测量指标、糖尿病相关指标、术后并发症。 结果 两组术前基线指标除年龄(P=0.027)外,差异均无统计学意义(P均> 0.05)。术后12个月LAGBP组多余体质量减少率(excess weight loss rate,% EWL)低于LSG组(57.52±13.53)% vs (73.43±10.78)%,P=0.000,但术后24个月(72.55±10.14)% vs (71.23±13.32)%,P=0.817、术后36个月(71.23±13.35)% vs (67.43±15.32)%,P=0.299两组% EWL无统计学差异。LAGB组与LSG组糖尿病缓解率分别为100%(9/9)、90.91%(10/11),差异无统计学意义(P=1.000)。LAGBP组手术时间(90.0±12.2) min vs (97.0±15.7) min,P=0.048、手术出血量(14.7±4.5) ml vs (20.3±10.8) ml,P=0.008、住院时间(4.3±0.8) d vs (6.2±1.5) d,P=0.000均低于LSG组。LAGBP组与LSG组术后并发症发生率分别为6.25%(2/32)、8.82%(3/34),差异无统计学意义(P=0.944)。 结论 与目前的主流术式LSG相比,LAGBP手术时间短、术中出血少、住院时间短,减重效果在术后2 ~ 3年时与LSG相当,是一种有效、安全、可逆的代谢新术式。

     

    Abstract: Objective To observe the efficacy and safety of laparoscopic adjustable gastric banding (LAGB) in the treatment of obesity and type 2 diabetes. Methods Patients with obesity who underwent LAGB (n=32) or laparoscopic sleeve gastrectomy(LSG) (n=34) in Chinese PLA General Hospital from April 2012 to April 2014 were enrolled in this study. Among them, there were 9 cases and 11 cases with type 2 diabetes in LAGBP group and LSG group, respectively. Anthropometric indicators, diabetesrelated indicators and postoperative complications were compared between the two groups. Results There was no significant difference between the two groups in preoperative baseline indicators (all P> 0.05) except age (P=0.027). The excess weight loss rates (%EWL) of LAGBP group was significantly lower than that of LSG group at 12 months after operation(57.52±13.53)% vs(73.43±10.78)%, P=0.000, but no significant difference was found at 24 and 36 months after operation(72.55±10.14)% vs(71.23±13.32)%, P=0.817; (71.23±13.35)% vs (67.43±15.32)%, P=0.299. The operating time(90.0±12.2) min vs (97.0±15.7)min, P=0.048, the amount of intraoperative blood loss(14.7±4.5) ml vs (20.3±10.8) ml, P=0.008 and the length of hospitalization(4.3±0.8) d vs (6.2±1.5) d, P=0.000 in group LAGBP were significantly lower than those in group LSG. While, there was no significant difference in T2DM remission rate (100% vs 90.91%, P=1.000) and incidence of postoperative complications (6.25% vs 8.82%, P=0.944) between two groups. Conclusion Compared with LSG, LAGB has shorter operating time, less intraoperative blood loss, shorter hospital stay and similar weight loss effect in the second to third year after operation, which is considered as an effective, safe and reversible metabolic procedure.

     

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