您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (9): 72-77.doi: 10.6040/j.issn.1671-7554.0.2021.1019

• 专家综述 • 上一篇    下一篇

我国腹腔镜技术治疗肥胖症手术方式的探索

仲明惟,胡三元   

  1. 山东大学附属山东省千佛山医院普通外科, 山东 济南 250014
  • 发布日期:2021-10-15
  • 通讯作者: 胡三元. E-mail:husanyuan1962@hotmail.com
  • 基金资助:
    国家自然科学基金(81770795)

Exploration of surgical treatment of obesity by laparoscopic techniques in China

ZHONG Mingwei, HU Sanyuan   

  1. Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong, China
  • Published:2021-10-15

RichHTML

5

PDF (PC)

314

摘要： 本世纪初,随着我国社会和经济的发展,肥胖症患者人数激增。肥胖症及其合并的代谢性疾病逐渐成为危害我国人民生命健康的主要疾病。国内普外科有志之士紧跟我国疾病谱的变化,开始了我国肥胖症外科治疗的探索。从最初学习应用国外的术式,到现在逐渐摸索出的适于我国的以腹腔镜袖状胃切除术为主要推广手术方式技术和理论体系,我国减重外科实现了从无到有、从星星之火逐渐展现出燎原之势的发展。本文主要就减重与代谢外科手术方式演变,尤其是国内减重与代谢手术方式的艰辛探索历程做详细的阐述。

关键词: 减重与代谢手术, 腹腔镜技术, 袖状胃切除术

Abstract: With the social and economic development of China, the number of obesity patients has increased dramatically at the beginning of this century. Obesity and comorbidities such as metabolic diseases have gradually become the main diseases that endanger the health of people. Domestic general surgeons keep up with the change of disease spectrum and start to explore surgical treatment of obesity. Initially, they studied and applied foreign surgical procedures, and now they have gradually developed the Chinese model of technical and theoretical system of laparoscopic sleeve gastrectomy, establishing the systematic bariatric surgery. This paper reviews the evolution of bariatric surgery and focuses on the exploration of bariatric surgery at home.

Key words: Bariatric surgery, Laparoscopy, Sleeve gastrectomy

中图分类号: 

  • R656.6+1
[1] Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures[J]. Obes Surg, 2018, 28(12): 3783-3794.
[2] 王存川, 张鹏, 赵玉沛. 腹腔镜袖状胃切除术操作指南(2018版)[J]. 中华肥胖与代谢病电子杂志, 2018, 4(4): 196-201. WANG Cunchuan, ZHANG Peng, ZHAO Yupei. The clinical guideline for laparoscopic sleeve gastrectomy procedure(2018 Edition)[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2018, 4(4): 196-201.
[3] 李梦伊, 刘洋, 张松海. 大中华减重与代谢手术数据库2020年度报告[J]. 中国实用外科杂志, 2021, 41(5): 533-542. LI Mengyi, LIU Yang, ZHANG Songhai. Greater China metabolic and bariatric surgery database registry report(2020)[J]. Chinese Journal of Practical Surgery, 2021, 41(5): 533-542.
[4] 王存川, 王宇澄. 减重手术的现状与展望[J]. 中国普外基础与临床杂志, 2019, 26(6): 641-644. WANG Cunchuan, WANG Yuchen. Current status and outlook of bariatric surgery [J]. Chinese Journal of Bases and Clinics in General Surgery, 2019, 26(6): 641-644.
[5] Jr GW, Bivins BA, Bell RM. The decline and fall of the jejunoileal bypass [J]. Surg Gynecol Obstet,1983,157(4):301-308.
[6] Mason EE, Ito C. Gastric bypass in obesity [J]. Surg Clin North Am, 1967, 47(6): 1345-1351.
[7] Griffen WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity [J]. Surg Obes Relat Dis, 2005, 1(2): 163-172.
[8] Scopinaro N. Why the operation I prefer is biliopancreatic diversion(BPD)[J]. Obesity Surgery, 1991, 1(3): 307-309.
[9] Saber AA, Elgamal MH, Mcleod MK. Bariatric surgery: the past, present, and future [J]. Obes Surg, 2008, 18(1): 121-128.
[10] Scopinaro N, Adami GF, Marinari GM, et al. Langzeitergebnisse mit der biliopankreatischen Umleitung zur Behandlung der morbiden Adipositas [J]. Acta Chirurgica Austriaca, 1998, 30(3): 166-171.
[11] Hess DS. Biliopancreatic diversion with duodenal Switch [J]. Surgery for Obesity & Related Diseases Official Journal of the American Society for Bariatric Surgery, 2011, 91(6): 1281-1293.
[12] Printen KJ, Mason EE. Gastric surgery for relief of morbid obesity [J]. Arch Surg, 1973, 106(4): 428-431.
[13] Laws HL, Piantadosi S. Superior gastric reduction procedure for morbid obesity: a prospective, randomized trial [J]. Ann Surg, 1981, 193(3): 334-340.
[14] Mason, Edward E. Vertical banded gastroplasty for obesity [J]. Archives of Surgery, 1982, 117(5): 701-706.
[15] 杨忠魁, 赵晓宇, 杨洪木, 等. Payne改良法治疗肥胖病一例[J]. 中华外科杂志, 1984, 22(3): 143-143. YANG Zhongkui, ZHAO Xiaoyu, Yang Hongmu, et al. A case of obesity treated by Paynes modified method [J]. Chinese Journal of Surgery, 1984, 22(3): 143-143.
[16] 郑成竹, 胡明根, 柯重伟, 等. 腹腔镜可调节捆扎带胃减容术治疗单纯重度肥胖症的临床应用[J]. 中华胃肠外科杂志, 2004, 7(5): 368-371. ZHENG Chengzhu, HU Minggen, KE Chongwei, et al. Laparoscopic adjustable gastric banding treatment for morbid obesity [J]. Chinese Journal of Gastrointestinal Surgery, 2004, 7(5): 368-371.
[17] 陈月, 邹大进, 郑成竹. 腹腔镜垂直束带式胃减容术治疗单纯性重度肥胖患者的疗效及安全性评价[J]. 解放军医学杂志, 2003,28(7): 618-619. CHEN Yue, ZOU Dajin, ZHENG Chengzhu. Evaluation on effects and safety of laparoscopic vertical banding gastroplasty in morbid obese subjects [J]. Medical Journal of Chinese Peoples Liberation Army, 2003, 28(7): 618-619.
[18] 王存川, 陈均金, 胡友主, 等. 腹腔镜Roux-en-y分流胃旁路减肥术1例报告[J].中国内镜杂志, 2004,10(12): 118-119. WANG Cunchuan, CHEN Junjin, HU Youzhu, et al. Laparoscopic roux-en-y gastric bypass for weight loss in one case report [J]. China Journal of Endoscopy, 2004, 10(12): 118-119.
[19] 郑成竹, 李际辉. 中国肥胖病外科治疗指南(2007)[J]. 中国实用外科杂志, 2007, 27(10): 759-762. ZHENG Chengzhu, LI Jihui. Chinese guidelines for the surgical treatment of obesity(2007)[J]. Chinese Journal of Practical Surgery, 2007, 27(10): 759-762.
[20] 王跃东, 叶再元, 竺杨文, 等. 腹腔镜袖套式胃减容术治疗病态性肥胖症[J]. 浙江医学, 2007, 29(3): 258-259. WANG Yuedong, YE Zaiyuan, ZHU Yangwen, et al. Laparoscopic sleeve gastrectomy for morbid obesity [J]. Zhejiang Medical Journal, 2007, 29(3): 258-259.
[21] 胡三元, Frezza EE, 李峰, 等. 腹腔镜胃袖套状切除减肥术(附1例报告)[J]. 腹腔镜外科杂志, 2007, 12(5): 370-373. HU Sanyuan, Frezza EE, LI Feng, et al. Clinical analysis of laparoscopic is sleeve gastrectomy in morbid obesity: with a report of one case [J]. Journal of Laparoscopic Surgery, 2007, 12(5): 370-373.
[22] 刘金钢, 田忠, 杨福全, 等. 腹腔镜袖状胃切除术治疗单纯性肥胖症1例报告[J]. 中国实用外科杂志, 2007,27(6): 481-482. LIU Jingang, TIAN Zhong, YANG Fuquan, et al. A case report of laparoscopic sleeve gastrectomy for simple obesity [J]. Chinese Journal of Practical Surgery, 2007,27(6): 481-482.
[23] Feng L, Zhang G, Liang J, et al. Sleeve gastrectomy provides a better control of diabetes by decreasing ghrelin in the diabetic Goto-kakizaki rats [J]. J Gastrointest Surg, 2009, 13(12): 2302.
[24] Chen W, Yan Z, Liu S, et al. The changes of pro-opiomelanocortin neurons in type 2 diabetes mellitus rats after ileal transposition: the role of POMC neurons [J]. J Gastrointest Surg, 2011, 15(9): 1618-1624.
[25] Sun D, Liu S, Zhang G, et al. Type 2 diabetes control in a nonobese rat model using sleeve gastrectomy with duodenal-jejunal bypass(SGDJB)[J]. Obes Surg, 2012(12): 1865-1873. doi:10.1007/s11695-012-0744-7.
[26] Liu S, Zhang G, Wang L, et al. The entire small intestine mediates the changes in glucose homeostasis after intestinal surgery in Goto-Kakizaki rats [J]. Ann Surg, 2012, 256(6): 1049-1058.
[27] Liu SZ, Sun D, Zhang GY, et al. A high-fat diet reverses improvement in glucose tolerance induced by duodenal-jejunal bypass in type 2 diabetic rats [J]. Chin Med J(Engl), 2012, 125(5): 912-919.
[28] Yan Z, Chen W, Liu S, et al. Myocardial insulin signaling and glucose transport are up-regulated in Goto-Kakizaki type 2 diabetic rats after ileal transposition [J]. Obes Surg, 2012, 22(3): 493-501.
[29] Zhiqing W, Jing W, Haili X, et al. Renal function is ameliorated in a diabetic nephropathy rat model through a duodenal-jejunal bypass [J]. Diabetes Res Clin Pract, 2014, 103(1): 26-34.
[30] Hu C, Zhang G, Sun D, et al. Duodenal-jejunal bypass improves glucose metabolism and adipokine expression independently of weight loss in a diabetic rat model [J]. Obes Surg, 2013, 23(9): 1436-1444.
[31] Sun D, Wang K, Yan Z, et al. Duodenal-jejunal bypass surgery up-regulates the expression of the hepatic insulin signaling proteins and the key regulatory enzymes of intestinal gluconeogenesis in diabetic Goto-Kakizaki rats [J]. Obes Surg, 2013, 23(11): 1734-1742.
[32] Cheng Y, Huang X, Wu D, et al. Sleeve gastrectomy with bypass of proximal small intestine provides better diabetes control than sleeve gastrectomy alone under postoperative high-fat diet [J]. Obes Surg, 2019, 29(1): 84-92.
[33] Liu T, Zhong MW, Liu Y, et al. Effects of sleeve gastrectomy plus trunk vagotomy compared with sleeve gastrectomy on glucose metabolism in diabetic rats [J]. World J Gastroenterol, 2017, 23(18): 3269-3278.
[34] Liu T, Zhong MW, Liu Y, et al. Diabetes recurrence after metabolic surgeries correlates with re-impaired insulin sensitivity rather than beta-cell function [J]. World J Gastroenterol, 2017, 23(19): 3468-3479.
[35] Zhong MW, Liu SZ, Zhang GY, et al. Effects of sleeve gastrectomy with jejuno-jejunal or jejuno-ileal loop on glycolipid metabolism in diabetic rats [J]. World J Gastroenterol, 2016, 22(32): 7332-7341.
[36] Wei M, Shao Y, Liu QR, et al. Bile acid profiles within the enterohepatic circulation in a diabetic rat model after bariatric surgeries [J]. Am J Physiol Gastrointest Liver Physiol, 2018, 314(5): G537-G546.
[37] Mahawar KK, Omar I, Singhal R, et al. The first modified Delphi consensus statement on sleeve gastrectomy [J]. Surg Endosc, 2021. doi: 10.1007/s00464-020-08216-w.
[38] Mui WL, Ng EK, Tsung BY, et al. Laparoscopic sleeve gastrectomy in ethnic obese Chinese [J]. Obes Surg, 2008, 18(12): 1571-1574.
[39] Zhang Y, Zhao H, Cao Z, et al. A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5-year outcome [J]. Obes Surg, 2014, 24(10): 1617-1624.
[40] Huang X, Liu T, Zhong M, et al. Predictors of glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass: a meta-analysis, meta-regression, and systematic review [J]. Surg Obes Relat Dis, 2018, 14(12): 1822-1831.
[41] Rogers AM. Predictors of glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass: A meta-analysis, meta-regression, and systematic review [J]. Surg Obes Relat Dis, 2019(1): e3-e4. doi: 10.1016/j.soard.2018.10.025.
[42] 马颖璋, 朱江帆, 忻颖, 等. 腹腔镜胃袖状切除加空回肠侧侧吻合术在治疗肥胖症中的应用价值[J]. 中华肥胖与代谢病电子杂志, 2016, 2(3): 142-145. MA Yingzhang, ZHU Jiangfan, XIN Ying, et al. Application value of laparoscopic sleeve gastrectomy plus side-to-side jejunoileal anastomosis in treating obesity [J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2016, 2(3): 142-145.
[43] 程玉刚. 袖状胃切除加近端小肠旁路术改善糖代谢的作用及机制研究[D]. 济南: 山东大学, 2019.
[44] Sun D, Liu S, Zhang G, et al. Sub-sleeve gastrectomy achieves good diabetes control without weight loss in a non-obese diabetic rat model [J]. Surg Endosc, 2014, 28(3): 1010-1018.
[45] 刘金刚, 郑成竹, 王勇. 中国肥胖和2型糖尿病外科治疗指南(2014)[J]. 中国实用外科杂志, 2014, 34(11): 1005-1010.
[46] 王勇, 王存川, 朱晒红, 等. 中国肥胖及2型糖尿病外科治疗指南(2019版)[J]. 中国实用外科杂志, 2019, 39(4): 301-306.
[47] 胡三元. 机器人辅助袖状胃切除术操作指南(2020年版)[J]. 腹腔镜外科杂志, 2021, 26(1): 1-6.
[1] 王延洲. 单孔腹腔镜技术在妇科恶性肿瘤中的应用体会[J]. 山东大学学报 (医学版), 2019, 57(12): 15-19.
[2] 关小明,张意茗,范晓东. 单孔腹腔镜技术的发展及展望[J]. 山东大学学报 (医学版), 2019, 57(12): 5-9.
[3] 谢海滨,武群政,刘少壮,黄鑫,程玉刚,胡三元,张光永. 肝线粒体相关内质网膜在袖状胃切除术改善糖尿病大鼠胰岛素敏感性中的作用[J]. 山东大学学报（医学版）, 2017, 55(10): 36-40.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 王焕亮,孙宝柱,杜洪玫,周长青,张丽. 不同麻醉监测指标调控异丙酚麻醉的比较[J]. 山东大学学报(医学版), 2006, 44(5): 471 -474 .
[2] 宋永红,马春红,吕红娟,朱传福,聂向民,王玫,刘艳,张萍 . 中国北方汉族人群HLA基因多态性研究[J]. 山东大学学报(医学版), 2007, 45(6): 546 -553 .
[3] 侯晓阳,卜培莉,张运,冯进波,刘春喜,李传保,郝明秀. 过氧化酶体增殖物激活受体α抑制血管紧张素Ⅱ促心肌纤维化作用的试验研究[J]. 山东大学学报(医学版), 2007, 45(7): 665 -668 .
[4] 曾季平,王丽娜,王立祥,任晓辉,张孟业,夏文,崔行. 氯化锰致PC12细胞损伤的研究[J]. 山东大学学报(医学版), 2006, 44(5): 467 -470 .
[5] 舒雅,齐峰. 下颌角托在肥胖患者全麻诱导中的应用[J]. 山东大学学报(医学版), 2007, 45(10): 1072 -1074 .
[6] 于慧1,2 ，陈少华1 ，赵家军2 ，高聆3
. 乙醇对人肝L02细胞糖原和GSK3β、PAMPK的影响[J]. 山东大学学报(医学版), 2009, 47(04): 75 -78 .
[7] . SWI显示弥漫性轴索损伤病灶个数与GCS评分相关性的分析[J]. 山东大学学报(医学版), 2009, 47(10): 126 -129 .
[8] . 原发性高血压家系与血压正常家系ACE基因I/D突变及CYP11B2基因单核苷酸多态性的相关性研究[J]. 山东大学学报(医学版), 2009, 47(7): 44 -48 .
[9] 郑金旭 顾燕兰 万兵. 糜酶抑制剂对肺纤维化的干预作用及其机制研究[J]. 山东大学学报(医学版), 2008, 46(12): 1132 -1135 .
[10] 于德新1，刘成2，李传福1，张晓明1，马祥兴1. 31PMRS在肝脏良、恶性占位性病变中的诊断价值[J]. 山东大学学报(医学版), 2009, 47(11): 118 -120 .
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发