摘要
目的 :探讨腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy, LSG)对肥胖型多囊卵巢综合征(polycystic ovary syndrome, PCOS)代谢改善的临床效果。方法:回顾分析我院33例接受LSG的肥胖型PCOS病例临床资料和术后6个月内随访结果。术后3、6个月复查代谢指标变化。结果:本研究PCOS病人平均年龄(27±5)岁,体质量指数(body mass index, BMI)均≥27.5,均伴月经紊乱或停经,按共识确诊为PCOS。术前BMI为(36.75±4.96),血清睾酮为(0.489±0.186)μg/L,促黄体素/促卵泡素(LH/FSH)为(1.72±0.90),胰岛素抵抗指数(HOMA-IR)为(14.14±16.79),糖化血红蛋白(HbA1c)为6.35%±1.41%。33例均顺利完成手术,无中转开腹和严重并发症发生。病人术后3、6个月BMI分别为(29.55±4.65)和(25.07±3.81),睾酮分别为(0.336±0.112)μg/L和(0.216±0.115)μg/L,LH/FSH分别为(1.68±1.08)和(1.28±0.95),HOMA-IR分别为(3.07±2.14)和(2.35±1.14),HbA1c分别为5.35%±0.40%和5.22%±0.30%。除LH/FSH(P>0.05)外,其他代谢指标术后3、6个月与术前差异均有统计学意义(P<0.05),且随时间延长呈下降趋势。术后3、6个月分别有11例(33.3%)和26(78.8%)月经紊乱情况得到缓解。术后3、6个月PCOS临床缓解率分别为51.5%(17例)和78.8%(26例)。结论:LSG可改善肥胖型PCOS病例的月经和排卵,缓解高雄激素血症等PCOS症状,其机制可能与胰岛素抵抗的减轻密切相关。
Objective To investigate the impact of laparoscopic sleeve gastrectomy(LSG) on metabolic improvement in obese patients with polycystic ovary syndrome(PCOS). Methods Thirty-three obese patients with PCOS who underwent LSG at our hospital were investigated retrospectively including clinical data and parameter changes in PCOS after 3 months and 6 months of follow-up. Results The average age of obese patients was(27±5) years and body mass index(BMI)all was ≥27.5. Patients had symptoms of menstrual disorders or amenorrhea and were diagnosed as PCOS according to Rotterdam ESHRE/ASRM-sponsored PCOS consensus. Preoperative BMI was(36.75 ±4.96), testosterone(TESTO)(0.489 ±0.186) μg/L, luteinizing hormone/follicle stimulating hormone(LH/FSH)(1.72±0.90), homeostatic model assessment-insulin resistance(HOMA-IR)(14.14±16.79) and glycosylated hemoglobin(HbA1 c) 6.35 % ±1.41 %. Operations were completed successfully without conversion to laparotomy and severe postoperative complications. Follow-up study showed that mean BMI was(29.55±4.65) at 3 months and(25.07±3.81) at 6 months postoperatively. Mean TESTO and LH/FSH were(0.336±0.112) μg/L and(1.68±1.08) at 3 months,(0.216±0.115) μg/L and(1.28±0.95) at 6 months postoperative respectively. Mean HOMA-IR was(3.07±2.14) and(2.35±1.14) at 3 months and 6 months follow-up, and HbA1 c was 5.35%±0.40% and 5.22%±0.30%, respectively. The decrease in BMI, TESTO, FPG, HOMA-IR, peptide C, HbA1 c, total cholesterol and triglyceride was found obviously at 3 months and 6 months postoperative compared to those preoperative with significant difference(P<0.05). The significant change in LH/FSH did not present at 3 months and 6 months after operation compared that before operation(P >0.05). At 3 months, 11(33.3%) of 33 cases with menstrual disorders including amenorrhea were in clinical remission and 26(78.8%) of 33 cases were at 6 months. PCOS in clinical remission was 17(51.5%) of 33 cases at 3 months of follow-up and 26(78.8%) of 33 cases at 6 months. Conclusions LSG has a significant effect on menstrual disorder and hyperandrogenism in obesity patients with PCOS by the mechanism of improving insulin resistance.
作者
马驰野
朱江帆
马颖璋
满琳
陆伟
张启颖
张亚丽
MA Chiye;ZHU Jiangfan;MA Yingzhang;MAN Lin;LU Wei;ZHANG Qiying;ZHANG Yali(Department of Bariatric and Metabolic Surgery,East Hospital,Tongji University,Shanghai 200124,China)
出处
《外科理论与实践》
2018年第6期506-510,共5页
Journal of Surgery Concepts & Practice
基金
中央高校基本科研业务费专项资金(22120180026)
