腹腔镜可调节胃绑带术治疗肥胖症及其合并症的疗效分析

摘要

目的：评价腹腔镜可调节胃绑带术（LAGB）治疗肥胖症及其合并症的中期疗效。方法对75例肥胖合并肥胖相关合并症患者采用 LAGB，其中15例联合行食管裂孔疝修补术，8例联合行胆囊切除术。术后门诊随访，观察调节绑带固定情况并记录体质量及合并症的变化。结果75例患者均顺利完成 LAGB，无中转开腹，平均手术时间（79．5±19．1）min，平均出血量（16．2±11．6）ml，平均术后住院时间（3．2±1．8）d，术后出现套管孔感染9例，饭后呕吐5例，经治疗治愈，无围手术期死亡。术后连续随访3～9年，平均5．3年，62例完成随访，失访率17．3％，术后1、2、3、5年平均多余体质量减少百分比（excess weight loss percent，EWL）分别为45．1％、61．3％、58．1％、51．6％，总减重有效率（EWL ＞50％为减重有效）为56．4％，无效率（EWL ＜25％）为12．9％。2型糖尿病、高血压、高脂血症、睡眠呼吸暂停综合征等多种肥胖合并症获得显著改善或治愈，4例不孕不育患者成功生育。胃绑带滑脱或减重效果不满意而在腹腔镜下取出绑带8例（12．9％），其中5例同期改行腹腔镜胃袖状切除术。暂时性脱发5例，对症饮食调整后缓解。4例因急性发作结石性胆囊炎行 LC。结论LAGB 治疗病态肥胖症减重效果可靠，对肥胖合并症的治疗作用也显著，合理选择患者、规范手术技巧和术后随访管理是改善疗效和减少中远期并发症的关键。%Objective To investigate the mid-term efficacy of laparoscopic gastric banding (LAGB)for morbid obesity and relatedcomplications.Method A total of 75 patients with morbid obesity and related complicationswere treated by LAGB.Of the 75 patients,1 5 patients underwent LAGB with con-current hiatal hernia repair and 8 patients with laparoscopic cholecystectomy.Patients were followed up and received gastric band adjustment.The decrease of body weight and complications remission were re-corded.Results All the operations were successfully completed.The operative time was(79.5 ±1 9.1 ) min,mean intraoperative blood loss was (1 6.2 ±1 1 .6 )ml,and mean postoperative hospital stay was (3.2 ±1 .8)d.A total of 1 4 patients developed postoperative complications,including 9 patients with inci-sion infection and 5 patients with vomit after meal,and all complications were cured by corresponding ther-apeutic intervention.There was no postoperative mortality.A total of 62 patients were successfully fol-lowedup for 3 ~9 years,andthe median follow-up time was 5.3 years.The lost follow-up rate was 1 7.3%. The excess weight loss percents (EWL)after 1 ,2,3,and 5years were 45.1 %,61 .3%,58.1 %,and 51 .6%,respectively.The overall effective rate(EWL% >50%)was 56.4%,and the failure rate(EWL <25%)was 1 2.9%.Obesity related complications such astype 2 diabetes,hypertension,hyperlipidemia,and sleep apnea-hypopnea syndrome were cured or significantly improved.Fourpatients with infertility had fer-tility after effective weight loss.Gastric band wasremoved laparoscopically in eight patients who were com-plicated with band slipping and ineffective weight loss rate.Five patients underwent concurrent laparoscop-ic sleeve gastrectomy as a revisional procedure.Five patients with temporary hair loss were relieved after diet modification.Fourpatients complicated with acute gallstone disease underwent laparoscopic cholecys-tectomy.Conclusion LAGB is safe and effective for treating morbid obesity and relatedcomplications.Pr-oper selection of patient,standardized surgical procedure,and follow-up management are critical to im-prove the efficacy of operation and reduce the midor long-term complications.