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Correlation of Short-term Weight Loss after Laparoscopic Sleeve Gastrectomy and Visceral Adipose Tissue Distribution in Patients with Moderate to Severe Obesity
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摘要:
目的 探讨中重度肥胖症患者腹部体脂分布与袖状胃切除术后近期减重效果的相关性。 方法 回顾性分析2015年11月至2017年8月, 在北京协和医院基本外科接受腹腔镜袖状胃切除术的单纯性中重度肥胖症患者的临床资料, 包括年龄、性别、身高、体质量及术前1周内腹部CT图像。通过西门子后处理工作站测定内脏脂肪面积、总脂肪面积及内脏脂肪比例。术后1、3、6个月分别随访患者体质量并计算体质量下降百分比(percentage of total weight loss, %TWL)和多余体质量下降百分比(percentage of excess weight loss, %EWL)。 结果 20例符合入选和排除标准的患者纳入本研究, 其中男性2例, 女性18例, 年龄(28.2±6.6)岁, 术前体质量为(118.5±20.9) kg, 体质量指数(body mass index, BMI)为(41.3±7.8) kg/m2, 脐平面平均内脏脂肪面积为(196.1±49.3) cm2, 皮下脂肪面积为(738.2±152.7) cm2, 总脂肪面积为(934.3±169.7) cm2, 内脏脂肪比例为(21.1±4.6)%。腹腔镜袖状胃切除术后1、3、6个月的体质量分别为(105.4±19.7) kg、(96.0±19.8) kg、(88.3±17.5) kg, BMI分别为(37.1±7.4) kg/m2、(33.8±7.6) kg/m2、(31.1±6.6) kg/m2, 均呈持续下降趋势, 平均%EWL分别达(29.3±9.7)%、(50.0±14.8)%、(65.3±18.1)%。术后1、3、6个月时达到成功减重(%EWL >50%)的比例分别为0、55%、70%。%EWL与术前体质量(R=-0.604, P=0.005)、BMI (R=-0.621, P=0.005)、总脂肪面积(R=-0.686, P=0.001)负相关, 与内脏脂肪比例正相关(R=0.504, P=0.024)。 结论 腹腔镜袖状胃切除术后近期减重效果明显, 术前低体质量、低BMI、高内脏脂肪比或许可以预测手术减重效果。 Abstract:Objective This study aimed to investigate the short-term weight loss after laparoscopic sleeve gastrectomy and its correlation with visceral adipose tissue distribution in patients with moderate to severe obesity. Methods The clinical information of moderately to severely simple obesity patients who underwent laparoscopic sleeve gastrectomy in Peking Union Medical College Hospital from November 2015 to August 2017 was retrospectively analyzed, including age, gender, height, body weight, and abdominal CT images within one week before the operation. The visceral adipose tissue area, total adipose tissue area, and visceral adipose tissue ratio weredetermined by a Siemens post-processing workstation. The body weight of the patients was followed up at 1, 3, and 6 months after surgery; the percentage of total weight loss (%TWL) and the percentage of excess weight loss (%EWL) were calculated. Results A total of 20 patients who met the inclusive and exclusive criteria were enrolled in this study, 2 men and 18 women, with an average age of (28.2±6.6) years old. Their preoperative weight was (118.5±20.9)kg, body mass index (BMI) was (41.3±7.8)kg/m2. At the umbilical plane level, the visceral adipose tissue, the subcutaneous adipose tissue, the total adipose tissue, and the visceral adipose tissue ratio were (196.1±49.3)cm2, (738.2±152.7)cm2, (934.3±169.7)cm2, and (21.1±4.6)%. At 1, 3, and 6 months after laparoscopic sleeve gastrectomy, the body weights were (105.4±19.7)kg, (96.0±19.8)kg, and (88.3±17.5)kg; BMIs were (37.1±7.4)kg/m2, (33.8±7.6)kg/m2, and (31.1±6.6)kg/m2; %EWLs were (29.3±9.7)%, (50.0±14.8)%, and (65.3±18.1)%, respectively; all these criteria showed a continuously downward trend. The proportions of successful weight loss (%EWL >50%) at 1, 3, and 6 months after surgery were 0, 55%, and 70%, respectively.%EWL was negatively correlated with the preoperative weight (R=-0.604, P=0.005), BMI (R=-0.621, P=0.005), total adipose tissue (R=-0.686, P=0.001), and positively corrected with the ratio of visceral adipose tissue (R=0.504, P=0.024). Conclusions Short-term weight loss after laproscopic sleeve gastrectomy is obvious. Low preoperative body weight, low BMI, and high visceral adipose tissue may be the predictors for effective weight loss after laparoscopic sleeve gastrectomy. -
Key words:
- obesity /
- sleeve gastrectomy /
- adipose tissue distribution /
- excess weight reduction
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表 1 20例袖状胃切除术减重患者术前、术后体脂参数变化
时间 体质量(kg) BMI (kg/m2) %TWL (%) %EWL (%) 术前 118.5±20.9 41.3±7.8 0 0 术后1个月 105.4±19.7 37.1±7.4 11.4±3.1 29.3±9.7 术后3个月 96.0±19.8 33.8±7.6 19.5±4.7 50.0±14.8 术后6个月 88.3±17.5 31.1±6.6 25.7±6.0 65.3±18.1 P值 ＜0.01 ＜0.01 ＜0.01 ＜0.01 BMI:体质量指数；%TWL:体质量下降百分比；%EWL:多余体质量下降百分比 
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表 2 20例袖状胃切除术减重患者减重效果与术前体脂参数的相关性
减重效果 术前体质量 BMI VAT TAT %VAT R值 P值 R值 P值 R值 P值 R值 P值 R值 P值 %TWL 术后1个月 -0.076 0.752 -0.099 0.752 0.077 0.746 -0.190 0.423 0.237 0.314 术后3个月 -0.205 0.387 -0.243 0.387 0.024 0.920 -0.330 0.155 0.321 0.168 术后6个月 0.062 0.796 0.047 0.796 0.201 0.394 -0.057 0.810 0.210 0.374 %EWL 术后1个月 -0.606 0.005 -0.628 0.005 -0.240 0.308 -0.685 0.001 0.469 0.037 术后3个月 -0.727 0.000 -0.756 0.000 -0.287 0.220 -0.810 0.000 0.543 0.013 术后6个月 -0.604 0.005 -0.621 0.005 -0.194 0.412 -0.686 0.001 0.504 0.024 %TWL、%EWL、BMI：同表 1；VAT:内脏脂肪面积；TAT:总脂肪面积；%VAT:内脏脂肪比例
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