Department of Bariatric and Metabolic Surgery, Jen-Ai Hospital, No. 483, Dongrong Rd., Dali Dist., Taichung City 412, Taiwan, Republic of China.
Department of Surgery, Central Clinic Hospital, Taipei, Taiwan.
Obes Surg. 2019 Apr;29(4):1148-1153. doi: 10.1007/s11695-018-3607-z.
Laparoscopic gastric clip (GC), a novel pure restrictive procedure, is a safe and effective treatment for morbid obesity. However, whether adding a proximal jejunal bypass (PJB) to this procedure might increase the efficacy is unknown.
Outcomes of 74 (43 women and 31male) obese patients who had undergone PJB-GC (41) or GC (33) for the treatment of type 2 diabetes mellitus (T2D) with 1 year follow-up were assessed. GC consists of creating a transverse gastric partition with a metallic clip. PJB consists of a jejuno-ileostomy between 20 and 320 cm distal to the ligament of Treitz. Postoperative body mass index (BMI) reduction, total weight loss (TWL), and remission rates of T2D were evaluated.
The preoperative clinical characters in both groups were similar. The mean operative time was significantly longer in the PJB-GC group than in the GC group. At 24 months after surgery, the BMI was lower (32.5 ± 6.2 vs. 37.0 ± 5.9 kg/m, p = 0.002) and weight loss higher in PJB-GC than GC (TWL 31.3 ± 14.8 vs. 23.5 ± 10.4%, p = 0.011). Remission of T2D was greater in the PJB-GC group (90.2 vs. 57.2%; p < 0.001).
In this study, PJB-GC was superior to GC in weight loss and T2D remission at 1 and 2 years after surgery. Adding PJB to GC increased the effect of weight loss and diabetic control.
腹腔镜胃夹（GC）是一种新型的纯限制手术，是治疗病态肥胖症的安全有效的方法。然而，这种方法是否通过添加近端空肠旁路术（PJB）来增加疗效还不得而知。
对 74 名（女性 43 名，男性 31 名）肥胖患者的治疗结果进行了评估，这些患者接受了 PJB-GC（41 名）或 GC（33 名）治疗 2 型糖尿病（T2D），并进行了 1 年随访。GC 包括用金属夹制作横向胃分隔。PJB 包括在Treitz 韧带远端 20 至 320cm 之间的空肠-回肠造口术。术后体重指数（BMI）减轻，总体重减轻（TWL）和 T2D 缓解率。
两组患者的术前临床特征相似。PJB-GC 组的手术时间明显长于 GC 组。手术后 24 个月，PJB-GC 组的 BMI 较低（32.5±6.2 vs. 37.0±5.9 kg/m，p=0.002），体重减轻量较高（TWL 31.3±14.8 vs. 23.5±10.4%，p=0.011）。PJB-GC 组 T2D 的缓解率更高（90.2 vs. 57.2%；p<0.001）。
在这项研究中，PJB-GC 在手术后 1 年和 2 年时在体重减轻和 T2D 缓解方面优于 GC。将 PJB 添加到 GC 中增加了减肥和控制糖尿病的效果。
