腹腔镜下袖状胃切除及袖状胃联合空肠-空肠侧侧吻合治疗非酒精性脂肪肝病效果对比分析

doi:10.3969/j.issn.1009-976X.2024.04.009

摘要/Abstract

摘要： 目的探讨腹腔镜下袖状胃及袖状胃切除联合空肠-空肠侧侧吻合治疗非酒精性脂肪肝病（NAFLD）缓解的效果。方法统计2018年1月至2022年12月我院符合条件减重病人临床资料及术后随诊资料,行历史性队列研究分析。根据手术方式不同将患者分为腹腔镜袖状胃切除（LSG）组及LSG+空肠-空肠侧侧吻合（JJB）组。使用倾向性评分匹配法（PSM）法对两组行1∶1匹配。比较PSM前、后两组患者一般资料和PSM后2组患者术后6个月及12个月NAFLD指标缓解情况。结果 PSM成功匹配两组75对患者,匹配后两组患者术前临床资料差异均无统计学意义（P>0.05）。术后6个月：两组BMI、体重、EWL%、LSM比较无统计学意义（P>0.05）。与LSG+JJB组比较,LSG组丙氨酸氨基转移酶（P<0.001）、天门冬氨酸氨基转移酶（P<0.001）、γ-谷氨酰转肽酶（P<0.001）、控制衰减指数（P=0.017）优于LSG+JJB,有统计学意义。血清总胆固醇（P<0.001）、甘油三酯（P=0.002）缓解差于LSG+JJB组,有统计学意义。术后12个月：两组在丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰转肽酶、瞬时弹性成像、控制衰减指数比较无统计学意义。LSG+JJB组在BMI（P=0.007）、EWL%（P=0.004）、体重（P=0.001）、血清总胆固醇（P=0.004）、甘油三酯（P<0.001）优于LSG组。结论术后1年两种手术方式在肝脏脂肪变性及纤维化的减轻方面无明显差异。LSG在术后早期对脂肪变性改善优于LSG+JJB,LSG+JJB对总胆固醇（TC）、甘油三酯（TG）缓解均优于LSG。

关键词: 袖状胃切除, 袖状胃联合空肠-空肠侧侧吻合, 非酒精性脂肪肝病

Abstract: Objective To analyze the effect of laparoscopic sleeve gastrectomy （LSG） and sleeve gastrectomy combined with jejunal bypass （LSG-JJB） in the treatment of non-alcoholic fatty liver disease（NAFLD. Methods The clinical data and postoperative follow-up data of eligible bariatric patients in our hospital from January 2018 to December 2022 were analyzed. A historical cohort study was conducted, patients were divided into LSG group and LSG+JJB group according to different surgical methods. Two groups were matched 1∶1 using the PSM method. The general data of the two groups before and after PSM were compared, and the NAFLD indexes remission of the two groups after PSM were compared at 6 months and 12 months after operation. Results Seventy-five pairs of patients in the two groups were successfully matched by PSM. There was no significant difference in preoperative clinical data between the two groups after matching （P>0.05）. 6 months after operation, There was no significant difference in BMI, body weight, EWL% and LSM between the two groups （P>0.05）. Compared with LSG+JJB group,ALT（P<0.001）, AST （P<0.001）,GGT （P<0.001） and CAP （P=0.017） in LSG group were superior to LSG+JJB group, with statistical significance. TC （P<0.001） and TG （P=0.002） in the LSG group were inferior to those in the LSG+JJB group. Twelve months after surgery： There were no significant differences in ALT、AST、GGT、LSM and CAP between the two groups. LSG+JJB group were superior to LSG group in BMI （P=0.007）, EWL% （P=0.004）, body weight （P=0.001）, TC （P=0.004） and TG（P<0.001）. Conclusion There is no significant difference in ameliorating hepatic steatosis and fibrosis between the two surgical methods at 1 year after operation. LSG has advantage on ameliorating steatosis in the early postoperative period, LSG+JJB is superior to LSG in total cholesterol （TC） and triglyceride （TG） remission.

Key words: pigmented nevus, scar, skin closure device

中图分类号:

R656.6

佟思羽, 曹关义, 王士平, 刘国栋. 腹腔镜下袖状胃切除及袖状胃联合空肠-空肠侧侧吻合治疗非酒精性脂肪肝病效果对比分析[J]. 岭南现代临床外科, 2024, 24(04): 254-259.

TONG Si-yu, CAO Guan-yi, WANG Shi-ping, LIU Guo-dong. Comparative analysis of laparoscopic sleeve gastrectomy and sleeve gastrectomy combined with jejunal bypass in the treatment of non-alcoholic fatty liver disease[J]. Lingnan Modern Clinics In Surgery, 2024, 24(04): 254-259.

参考文献

[1] Le MH, Yeo YH, Li X, et al.2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis[J]. Clin Gastroenterol Hepatol, 2022, 20(12): 2809-2817.e28.
[2] Jiang W, Mao X, Liu Z, et al.Global burden of nonalcoholic fatty liver disease, 1990 to 2019: findings from the global burden of disease study 2019[J]. J Clin Gastroenterol, 2023, 57(6): 631-639.
[3] Chalasani N, Younossi Z, Lavine JE, et al.The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases[J]. Hepatology, 2018, 67(1): 328-357.
[4] Verrastro O, Panunzi S, Castagneto-Gissey L, et al.Bariatric-metabolic surgery versus lifestyle intervention plus best medical care in non-alcoholic steatohepatitis (BRAVES): a multicentre, open-label, randomised trial[J]. Lancet, 2023, 401(10390): 1786-1797.
[5] Perysinakis I, Pappis HC, Margaris E.Current Controversies in Metabolic Surgery for Nonalcoholic Fatty Liver Disease[J]. Obes Surg, 2019, 29(3):1058-1067.
[6] Lee Y, Doumouras AG, Yu J, et al. Complete resolution of nonalcoholic fatty liver disease after bariatric surgery: a systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol, 2019, 17(6): 1040-1060. e11.
[7] 陈伟, 罗衡桂, 赵象文, 等. 腹腔镜袖状胃切除术对重度肥胖患者非酒精性脂肪肝病及糖脂代谢的短期影响[J]. 中华肥胖与代谢病电子杂志, 2020, 6(03): 153-158.
[8] 杨家林, 彭勇. 减重手术治疗非酒精性脂肪性肝病的研究进展[J]. 中国现代普通外科进展, 2021, 24(1): 51-53+57.
[9] Li J, Delamarre A, Wong VWS, et al.Diagnosis and assessment of disease severity in patients with nonalcoholic fatty liver disease[J]. United European Gastroenterol J, 2024, 12(2): 219-225.
[10] Salman MA, Mikhail HMS, Nafea MA, et al.Impact of laparoscopic sleeve gastrectomy on fibrosis stage in patients with child- A NASH-related cirrhosis[J]. Surg Endosc, 2021, 35: 1269-1277.
[11] Liu YW, Wong WS, Wong KH,et al.A prospective 5-year study on the use of transient elastography to monitor the improvement of non-alcoholic fatty liver disease following bariatric surgery[J]. Sci Rep, 2021, 11(1):5416.
[12] Nogami A, Yoneda M, Kobayashi T, et al.Assessment of 10‐year changes in liver stiffness using vibration‐controlled transient elastography in non‐alcoholic fatty liver disease[J]. Hepatol Res, 2019, 49(8): 872-880.
[13] Lee HW, Wong GLH, Kwok R, et al.Serial transient elastography examinations to monitor patients with type 2 diabetes: a prospective cohort study[J]. Hepatology, 2020, 72(4): 1230-1241.
[14] Fakhry TK, Mhaskar R, Schwitalla T, et al.Bariatric surgery improves nonalcoholic fatty liver disease: a contemporary systematic review and meta-analysis[J]. Surg Obes Relat Dis. 2019, 15(3): 502-511.
[15] Gudan A, Kozłowska-Petriczko K, Wunsch E, et al.Small intestinal bacterial overgrowth and non-alcoholic fatty liver disease: what do we know in 2023?[J]. Nutrients, 2023, 15(6): 1323.
[16] Sepúlveda M, Alamo M, Astorga C, et al.Histologic and microbiological findings of the defunctionalized loop in sleeve gastrectomy with jejunal bypass[J]. Surg Obes Relat Dis, 2021, 17(1): 131-138.
[17] Zhou H, Luo P, Li P, et al.Bariatric Surgery Improves Nonalcoholic Fatty Liver Disease: Systematic Review and Meta-Analysis[J]. Obes Surg, 2022, 32(6): 1872-1883.
[18] Lin S, Li C, Guan W, et al.Three-Year Outcomes of Sleeve Gastrectomy Plus Jejunojejunal Bypass: a Retrospective Case-Matched Study with Sleeve Gastrectomy and Gastric Bypass in Chinese Patients with BMI ≥35 kg/m2[J]. Obes Surg, 2021, 31(8): 3525-3530.
[19] Sepulveda M, Alamo M, Preiss Y, et al.Metabolic surgery comparing sleeve gastrectomy with Jejunal bypass and Roux-en-Y gastric bypass in type 2 diabetic patients after 3 years[J]. Obes Surg, 2018, 28(11): 3466-3473.
[20] Zhen Q I, Shenglong LE, Cheng R, et al.Responses of the Serum Lipid Profile to Exercise and Diet Interventions in Nonalcoholic Fatty Liver Disease[J]. Med Sci Sports Exerc, 2024, 56(6): 1036-1045.