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 (HbA1c) 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 HbA1c was 5.35%±0.40% and 5.22%±0.30%, respectively. The decrease in BMI, TESTO, FPG, HOMA-IR, peptide C, HbA1c, 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.
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