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目的探讨腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)治疗超级肥胖症(指体质量指数≥50 kg/m2)的临床疗效及经验。方法回顾性分析2013年5月至2015年5月在广州军区广州总医院甲乳糖尿病外科及广州中医药大学金沙洲医院接受LSG手术的17例随访满1年的超级肥胖症患者的物理指标、多余体质量下降百分比(percentage of excess weight loss,EWL%)及肥胖相关代谢指标。结果 17例患者均顺利完成手术,无中转开腹及死亡患者。手术时间70~278 min,平均(140.4±56.8)min;术中出血量20~200 ml,平均(65.0±44.7)ml;术后进食时间2~5 d,平均(2.5±0.2)d;术后住院时间7~24 d,平均(12.8±4.1)d。术后1年患者EWL%(87.1±25.7)%、物理指标均有明显下降,差异有统计学意义(P<0.01),肥胖相关代谢指标中血三酰甘油、血尿酸及尿微量白蛋白均有明显下降,差异有统计学意义(P<0.01),无严重并发症。结论 LSG作为一种独立的减重术式对超级肥胖症患者有良好的减重效果,具有调脂降尿酸的作用,多学科团队协作模式、术前充分准备、术中麻醉配合、手术经验和技巧、术后饮食管理是围手术期安全的重要保证。
Objective To investigate the clinical efficacy and experience of laparoscopic sleeve gastrectomy (LSG) in the treatment of hyper-obesity (body mass index≥50 kg / m2). Methods A retrospective analysis was conducted on the physical parameters of 17 patients with hyper-obesity who underwent LSG surgery at the Guangzhou General Hospital of Guangzhou Military Region from May 2013 to May 2015 at Guangzhou Diabetes Surgical Hospital of Guangzhou General Hospital and at Jinshazhou Hospital of Guangzhou University of Chinese Medicine. Percentage of excess weight loss (EWL%) and obesity-related metabolic parameters. Results All the 17 patients successfully completed the operation without conversion to open surgery and death. The operative time was 70 ~ 278 min (mean, 140.4 ± 56.8) min. The intraoperative blood loss was 20 ~ 200 ml, with an average of (65.0 ± 44.7) ml. The average duration of operation was 2.5 ± 0.2 days After hospitalization for 7 to 24 days, with an average of (12.8 ± 4.1) days. One year after operation, the EWL% (87.1 ± 25.7)% and physical indexes decreased significantly (P <0.01). The triglyceride, serum uric acid and urine microalbumin in obesity-related metabolic indexes There was a significant decline, the difference was statistically significant (P <0.01), no serious complications. Conclusion LSG as an independent weight-loss procedure has a good weight-loss effect on patients with super obesity, has the role of lipid-lowering and uric acid lowering, multidisciplinary teamwork mode, adequate preparation before operation, intraoperative anesthesia and operation experience Skills, postoperative diet management is an important guarantee for perioperative safety.