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网膜切除术对腹腔镜 Roux-en-Y 胃旁路术治疗 III 级肥胖患者代谢综合征、急性期反应物和炎症介质的潜在附加影响:一项随机试验。

Potential additional effect of omentectomy on metabolic syndrome, acute-phase reactants, and inflammatory mediators in grade III obese patients undergoing laparoscopic Roux-en-Y gastric bypass: a randomized trial.

机构信息

Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Tlalpan, Mexico.

出版信息

Diabetes Care. 2010 Jul;33(7):1413-8. doi: 10.2337/dc09-1833.

Abstract

OBJECTIVE

To assess the additional effect of sudden visceral fat reduction by omentectomy on metabolic syndrome, acute-phase reactants, and inflammatory mediators in patients with grade III obesity (G-III O) undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB).

RESEARCH DESIGN AND METHODS

Twenty-two patients were randomized into two groups, LRYGB alone or with omentectomy. Levels of interleukin-6, C-reactive protein, tumor necrosis factor-alpha, leptin, adiponectin, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides, as well as clinical characteristics, were evaluated before surgery and at 1, 3, 6, and 12 months after surgery. Results were compared between groups.

RESULTS

Baseline characteristics were comparable in both groups. Mean operative time was significantly higher in the group of patients who underwent omentectomy (P < 0.001). Median weight of the omentum was 795 +/- 341 g. In one patient, a duodenal perforation occurred at the time of omentectomy. BMI, blood pressure, glucose, total cholesterol, LDL, and triglycerides significantly improved in both groups at 1, 3, 6, and 12 months of follow-up when compared with basal values. However, there were no consistent statistically significant differences among the groups in terms of metabolic syndrome components, acute-phase reactants, and inflammatory mediators.

CONCLUSIONS

Omentectomy does not have an ancillary short-term significant impact on the components of metabolic syndrome and does not induce important changes in the inflammatory mediators in patients undergoing LRYGB. Operative time is more prolonged when omentectomy is performed.

摘要

目的

评估在腹腔镜 Roux-en-Y 胃旁路术(LRYGB)治疗 3 级肥胖(G-III O)患者中,网膜切除术对代谢综合征、急性期反应物和炎症介质的影响。

研究设计与方法

22 例患者随机分为两组,LRYGB 单独或联合网膜切除术。在手术前和手术后 1、3、6 和 12 个月评估白细胞介素 6、C 反应蛋白、肿瘤坏死因子-α、瘦素、脂联素、血糖、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和甘油三酯水平以及临床特征。比较两组结果。

结果

两组基线特征相当。行网膜切除术患者的手术时间明显更长(P < 0.001)。网膜的平均重量为 795 ± 341 g。在 1 例患者中,网膜切除时发生十二指肠穿孔。与基础值相比,两组患者在术后 1、3、6 和 12 个月时 BMI、血压、血糖、总胆固醇、LDL 和甘油三酯均显著改善。然而,两组在代谢综合征成分、急性期反应物和炎症介质方面没有一致的统计学显著差异。

结论

在接受 LRYGB 的患者中,网膜切除术短期内对代谢综合征的成分没有辅助作用,也不会引起炎症介质的重要变化。当进行网膜切除术时,手术时间会延长。

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