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

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