Ultrasound evaluation of gastric physiology and metabolic response in patients with gastric antrum retention during sleeve gastrectomy
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摘要: [目的]腹腔镜袖状胃切除手术是减肥手术中最常用的技术之一, 但对于从幽门开始胃切除的最佳距离尚未达成共识。本研究旨在探讨超声评估袖状胃切除手术胃窦保留患者胃生理机能与代谢反应的相关性。[方法]选取2016年1月~2018年12月在我院就诊的体重指数 ≥ 50 kg/m2患者50例, 随机分为2组。在全身麻醉下行LSG手术, 在术中用条带测量从幽门到第一部分点的距离 (对于3 cm组距离为3 cm, 8 cm组距离为8 cm), 分别为3 cm组和8 cm组, 又在上述2组中根据受试者有无糖尿病, 分为糖尿病组和非糖尿病组。评估在手术之前、手术后6个月以及手术后12个月的体重变化情况、胃容积以及血清葡萄糖水平、糖基化血红蛋白、胰岛素、HOMA-IR、C-肽 (pg/mL)、胰高血糖素样肽1、胃抑制剂多肽。[结果]在本研究中, 2个干预组在手术后体重均出现显著下降。3 cm组的体重下降幅度高于8 cm组, 与8 cm组相比, PEBMIL的结果差异较小。体积成像测试表明, 手术后6个月, 2组的体积明显降低, 但切除距幽门8 cm组较高 (P=0.00)。术后6个月和12个月2组胃排空速度均显著增加, 但3 cm组的速度更快。在非糖尿病患者组中, 3 cm组的胃排空速度显著更高。3 cm组患者的血糖曲线与8 cm组患者的血糖曲线无显著差异。在肠促胰岛素 (GLP-1和GIP) 浓度或肽浓度方面, 3 cm组和8 cm组之差异无统计学意义。[结论]胃窦切除术患者的胃排空速度更快, 袖状胃切除手术胃窦保留患者从幽门开始胃切除的距离不影响糖尿病患者的胃排空, 该手术胃切除的距离不影响GLP-1和GIP或C-肽的浓度。Abstract: [Objective]Laparoscopic sleeve gastrectomy is one of the most commonly used techniques for weight loss surgery, but there is no consensus on the optimal distance for gastric resection from the pylorus.This study was designed to investigate the correlation between ultrasound physiology and metabolic response in patients with gastric sinus retention during sleeve gastrectomy.[Methods]50 patients with body mass index ≥ 50 kg/m2 who were admitted to our hospital from January 2016 to December 2018 were randomly divided into two groups, 3 cm group and 8 cm group.LSG surgery was performed under general anesthesia, and the distance from the pylorus to the first part point was measured during the operation (3 cm for the 3 cm group and 8 cm for the 8 cm group), 3 cm group and 8 cm group, respectively.The patients were divided into a diabetic group and a non-diabetic group according to whether or not the subject had diabetes.Assessment of body weight changes before surgery, 6 months after surgery, and 12 months after surgery, gastric volume and serum glucose levels, glycosylated hemoglobin, insulin, HOMA-IR, C-peptide (pg/mL), pancreatic height Glucagon-like peptide 1, gastric inhibitor polypeptide.[Results]In this study, both intervention groups showed significant weight loss after surgery.The weight loss of the 3 cm group was higher than that of the 8 cm group, and the difference in PEBMIL was smaller than that of the 8 cm group.Volume imaging tests showed that the volume of the two groups was significantly reduced 6 months after surgery, but the group was 8 cm higher than the pylorus (P=0.00).The gastric emptying rate was significantly increased in both groups at 6 and 12 months after surgery, but the 3 cm group was faster.In the non-diabetic group, the gastric emptying rate was significantly higher in the 3 cm group.There was no significant difference in blood glucose profiles between the 3 cm group and the 8 cm group.There was no significant difference between the 3 cm group and the 8 cm group in terms of incretin (GLP-1 and GIP) concentrations or peptide concentrations.[Conclusion]Patients with gastric antrum resection have a faster gastric emptying rate.Sleeve-gastrostomy Gastric sinus retention The distance from the pylorus to gastric resection in patients does not affect gastric emptying in diabetic patients.The distance from the surgical gastrectomy does not affect the concentration of incretin (GLP-1 and GIP) or C-peptide.
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[1] 顾佳毅, 朱纯超, 徐佳, 等.腹腔镜辅助保留幽门的胃切除术[J].中华胃肠外科杂志, 2017, 20 (8):952-952.
[2] González García A, Álvarez Bueno C, Lucas de la Cruz L, et al.[PREVALENCE OF THINNESS, OVERWEIGHT AND OBESITY AMONG 4-TO-6-YEAR-OLD SPANISH SCHOOLCHILDREN IN 2013;SITUATION IN THE EUROPEAN CONTEXT] [J].Nutr Hosp, 2014, 32 (4):1476-1482.
[3] Chambers A P, Smith E P, Begg D P, et al.Regulation of Gastric Emptying Rate and its Role in Nutrient-Induced GLP-1 Secretion in Rats after Vertical Sleeve Gastrectomy[J].Am J Physiol Endocrinol Metab, 2014, 306 (4):E424-E432.
[4] Beamish AJ, Olbers T.The Role of Bariatric Surgery in the Management of Morbid Childhood Obesity[J].Current Pediatrics Reports, 2015, 3 (4):259-266.
[5] 卢炜, 陆江, 卢劲晔, et al.袖状胃切除术对糖尿病犬糖代谢的影响[J].江苏农业科学, 2015, 43 (12):256-259.
[6] Leyba JL, Llopis SN, Aulestia SN.Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy for the Treatment of Morbid Obesity.A Prospective Study with 5 Years of Follow-Up[J].Obesity Surgery, 2014, 24 (12):2094-2098.
[7] 魏珂, 曹俊, 彭丽桦, 等.肺复张对病态肥胖患者腹腔镜袖状胃切除术围术期肺功能的影响[J].中华麻醉学杂志, 2016, 36 (1):26-29.
[8] Acquafresca PA, Palermo M, Rogula T Most common robotic bariatric procedures:review and technical aspects[J].Ann Surg Innov Res, 2015, 9 (1):9-9.
[9] 陆江, 卢炜, 朱道仙, 等.袖状胃切除术在治疗中小型犬肥胖症中的应用[J].江苏农业科学, 2014, 42 (5):173-175.
[10] Guenthert SJ, Stier C, Weiner RA, et al.Tu1466 Improvement in Glucose Metabolism After Bariatric Surgery:Comparison of Laparoscopic Roux-en-Y Gastric Bypass and Duodenojejunal Bypass Liner[J].Gastroenterology, 2015, 148 (4):S-900.
[11] Bekheit M, Abdel-Baki TN, Gamal M, et al.Influence of the Resected Gastric Volume on the Weight Loss After Laparoscopic Sleeve Gastrectomy[J].Obesity Surgery, 2016, 26 (7):1505-1510.
[12] 夏泽锋, 杜锦鹏, 陶凯雄, 等.袖状胃切除术治疗2型糖尿病机制的研究进展[J].中华消化外科杂志, 2018, 17 (6):640-640.
[13] Kishimoto M, Noda M.Effects of Exenatide in a Morbidly Obese Patient with Type 2 Diabetes[J].Diabetes Therapy, 2014, 5 (1):323-332.
[14] 钱春花, 朱翠玲, 高晶扬, 等.腹腔镜袖状胃切除术对病态肥胖患者胰岛素分泌模式的影响和机制探讨[J].中华胃肠外科杂志, 2018, 21 (1):61-61.
[15] 王恺京, 徐安安, 周小钢, 等胃袖状切除联合空回肠侧侧吻合术对2型糖尿病大鼠减重与改善代谢的影响[J].中华消化外科杂志, 2015, 14 (7):564-568.
[16] Neff K J, Roux C W L.Mechanisms of Action of Bariatric Surgical Procedures[M]//Obesity, Bariatric and Metabolic Surgery.Springer International Publishing, 2016.
[17] Seki Y, Kasama K, Hashimoto K.Long-Term Outcome of Laparoscopic Sleeve Gastrectomy in Morbidly Obese Japanese Patients[J].Obes Surg, 2016 (1):1-8.
[18] 应夏洋, 沈柏用, 金佳斌, 等腹腔镜胃袖状切除术后剩余胃体积与减重效果的关系[J].中华消化外科杂志, 2015, 14 (7):550-554.
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