• 華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬同濟(jì)醫(yī)院整形外科(湖北武漢 430030);

目的根據(jù)胃腸道不同部位激素分泌的特點(diǎn)，探討一種新的長(zhǎng)期減重效果明顯的手術(shù)方式。方法高脂飲食誘導(dǎo)Wistar肥胖大鼠35只，然后將誘導(dǎo)成功的肥胖大鼠按完全隨機(jī)方法分為改良胃袖狀切除術(shù)組(n=12)、胃袖狀切除術(shù)組(n=12)及假手術(shù)組(n=11)3組，分別比較3組大鼠術(shù)前、術(shù)后連續(xù)8周的體重和攝食量，以及術(shù)前及術(shù)后第8周時(shí)外周血清中生長(zhǎng)激素釋放肽ghrelin和胰高血糖素樣肽-1(GLP-1)水平的變化。結(jié)果①大鼠體重和攝食量： 3組間術(shù)前大鼠的體重和攝食量差異均無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。改良胃袖狀切除術(shù)組和胃袖狀切除術(shù)組術(shù)后1~8周，大鼠的體重均較假手術(shù)組明顯下降(P lt;0.05)，改良胃袖狀切除術(shù)組較胃袖狀切除術(shù)組大鼠的體重也明顯下降(P lt;0.05)。改良胃袖狀切除術(shù)組術(shù)后1~8周大鼠的攝食量較假手術(shù)組明顯減少(P lt;0.05)，改良胃袖狀切除術(shù)組于術(shù)后3、6、7及8周大鼠的攝食量較胃袖狀切除術(shù)組大鼠明顯減少(P lt;0.05)。②外周血清中g(shù)hrelin和GLP-1水平： 3組間術(shù)前大鼠ghrelin和GLP-1水平變化差異均無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05); 術(shù)后第8周，血清ghrelin水平改良胃袖狀切除術(shù)組和胃袖狀切除術(shù)組均較假手術(shù)組明顯下降(P lt;0.05)，改良胃袖狀切除術(shù)組又較胃袖狀切除術(shù)組明顯下降(P lt;0.05); GLP-1水平改良胃袖狀切除術(shù)組較假手術(shù)組和胃袖狀切除術(shù)組明顯升高(P lt;0.05)。同時(shí)，術(shù)后第8周時(shí)改良胃袖狀切除術(shù)組和胃袖狀切除術(shù)組ghrelin水平較術(shù)前明顯下降(P lt;0.05)，GLP-1水平在改良胃袖狀切除術(shù)組較術(shù)前明顯升高(P lt;0.05)。結(jié)論改良胃袖狀切除術(shù)在肥胖大鼠模型中成功實(shí)施為進(jìn)一步探索其臨床應(yīng)用提供了可能。

引用本文： 嚴(yán)玲玲,朱占永,吳丹,吳毅平. 改良胃袖狀切除對(duì)肥胖大鼠ghrelin及胰高血糖素樣肽-1水平的影響. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(5): 498-502. doi: 復(fù)制

1. Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after dietinduced weight loss or gastric bypass surgery [J]. N Engl J Med, 2002, 346(21): 16231630.
2. Samer G, Mattar MD. Lifting the unbearable weight of morbid obesity [J]. Ann Surg, 2008, 247(1): 2829.
3. 張洪義. 外科手術(shù)治療病態(tài)性肥胖癥的現(xiàn)代進(jìn)展 [J]. 空軍總醫(yī)院學(xué)報(bào), 2006, 22(3): 165167.
4. Safer DJ. Diet, behavior modification, and exercise: a review of obesity treatments from a longterm perspective [J]. South Med J, 1991, 84(12): 14701474.
5. Clark A, Franklin J, Pratt I, et al. Overweight and obesity-use of portion control in management [J]. Aust Fam Physician, 2010, 39(6): 407411.
6. Hearnshaw C, Matyka K. Managing childhood obesity: when lifestyle change is not enough [J]. Diabetes Obes Metab, 2010, 12(11): 947957.
7. Chang CY, Huang CK, Chang YY, et al. Prospective study of healthrelated quality of life after RouxenY bypass surgery for morbid obesity [J]. Br J Surg, 2010, 97(10): 15411546.
8. Hüttl TP, Jauch KW. Surgical therapy of morbid obesity [J]. MMW Fortschr Med, 2010, 152(22): 3235.
9. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weightloss procedure for highrisk patients with morbid obesity [J]. Surg Endosc, 2006, 20(6): 859863.
10. Kodama Y, Zhao CM, Kulseng B, et al. Eating behavior in rats subjected to vagotomy, sleeve gastrectomy, and duodenal switch [J]. J Gastrointest Surg, 2010, 14(10): 15021510.
11. Rice RD, Simon TE, Seery JM, et al. Laparoscopic sleeve gastrectomy: outcomes at a military training center [J]. Am Surg, 2010, 76(8): 835840.
12. Himpens J, Dobbeleir J, Peeters G. Longterm results of laparoscopic sleeve gastrectomy for obesity [J]. Ann Surg, 2010, 252(2): 319324.
13. Langer FB, Bohdjalian A, ShakeriLeidenmühler S, et al. Conversion from sleeve gastrectomy to RouxenY gastric bypassindications and outcome [J]. Obes Surg, 2010, 20(7): 835840.
14. Suzuki K, Simpson KA, Minnion JS. The role of gut hormones and the hypothalamus in appetite regulation [J]. Endocr J, 2010, 57(5): 359372.
15. Maljaars J, Romeyn EA, Haddeman E, et al. Effect of fat saturation on satiety, hormone release, and food intake [J]. Am J Clin Nutr, 2009, 89(4): 10191024.
16. 鄧治洲, 王烈, 林憶陽(yáng), 等. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效觀察及其對(duì)胰高血糖素樣肽1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(6): 466469.
17. Shin AC, Zheng H, Townsend RL, et al. Mealinduced hormone responses in a rat model of RouxenY gastric bypass surgery [J]. Endocrinology, 2010, 151(4): 15881597.
18. Laferrère B. Effect of gastric bypass surgery on the incretins [J]. Diabetes Metab, 2009, 35(6 Pt 2): 513517.
19. Bueter M, Ashrafian H, le Roux CW. Mechanisms of weight loss after gastric bypass and gastric banding [J]. Obes Facts, 2009, 2(5): 325331.
20. Ursavas A, Ilcol YO, Nalci N, et al. Ghrelin, leptin, adiponectin, and resistin levels in sleep apnea syndrome: Role of obesity [J]. Ann Thorac Med, 2010, 5(3): 161165.
21. Aguirre V, Stylopoulos N, Grinbaum R, et al. An endoluminal sleeve induces substantial weight loss and normalizes glucose homeostasis in rats with dietinduced obesity [J]. Obesity, 2008, 16(12): 25852592.
22. AbuJaish W, Rosenthal RJ. Sleeve gastrectomy: a new surgical approach for morbid obesity [J]. Expert Rev Gastroenterol Hepatol, 2010, 4(1): 101119.
23. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure [J]. Surg Obes Relat Dis, 2009, 5(4): 469475.
24. Nowak A, Bojanowska E. Effects of peripheral or central GLP1 receptor blockade on leptininduced suppression of appetite [J]. J Physiol Pharmacol, 2008, 59(3): 501510.
25. Iannelli A, Dainese R, Piche T, et al. Laparoscopic sleeve gastrectomy for morbid obesity [J]. World J Gastroenterol, 2008, 14(6): 821827.
  1. 1. Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after dietinduced weight loss or gastric bypass surgery [J]. N Engl J Med, 2002, 346(21): 16231630.
  2. 2. Samer G, Mattar MD. Lifting the unbearable weight of morbid obesity [J]. Ann Surg, 2008, 247(1): 2829.
  3. 3. 張洪義. 外科手術(shù)治療病態(tài)性肥胖癥的現(xiàn)代進(jìn)展 [J]. 空軍總醫(yī)院學(xué)報(bào), 2006, 22(3): 165167.
  4. 4. Safer DJ. Diet, behavior modification, and exercise: a review of obesity treatments from a longterm perspective [J]. South Med J, 1991, 84(12): 14701474.
  5. 5. Clark A, Franklin J, Pratt I, et al. Overweight and obesity-use of portion control in management [J]. Aust Fam Physician, 2010, 39(6): 407411.
  6. 6. Hearnshaw C, Matyka K. Managing childhood obesity: when lifestyle change is not enough [J]. Diabetes Obes Metab, 2010, 12(11): 947957.
  7. 7. Chang CY, Huang CK, Chang YY, et al. Prospective study of healthrelated quality of life after RouxenY bypass surgery for morbid obesity [J]. Br J Surg, 2010, 97(10): 15411546.
  8. 8. Hüttl TP, Jauch KW. Surgical therapy of morbid obesity [J]. MMW Fortschr Med, 2010, 152(22): 3235.
  9. 9. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weightloss procedure for highrisk patients with morbid obesity [J]. Surg Endosc, 2006, 20(6): 859863.
  10. 10. Kodama Y, Zhao CM, Kulseng B, et al. Eating behavior in rats subjected to vagotomy, sleeve gastrectomy, and duodenal switch [J]. J Gastrointest Surg, 2010, 14(10): 15021510.
  11. 11. Rice RD, Simon TE, Seery JM, et al. Laparoscopic sleeve gastrectomy: outcomes at a military training center [J]. Am Surg, 2010, 76(8): 835840.
  12. 12. Himpens J, Dobbeleir J, Peeters G. Longterm results of laparoscopic sleeve gastrectomy for obesity [J]. Ann Surg, 2010, 252(2): 319324.
  13. 13. Langer FB, Bohdjalian A, ShakeriLeidenmühler S, et al. Conversion from sleeve gastrectomy to RouxenY gastric bypassindications and outcome [J]. Obes Surg, 2010, 20(7): 835840.
  14. 14. Suzuki K, Simpson KA, Minnion JS. The role of gut hormones and the hypothalamus in appetite regulation [J]. Endocr J, 2010, 57(5): 359372.
  15. 15. Maljaars J, Romeyn EA, Haddeman E, et al. Effect of fat saturation on satiety, hormone release, and food intake [J]. Am J Clin Nutr, 2009, 89(4): 10191024.
  16. 16. 鄧治洲, 王烈, 林憶陽(yáng), 等. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效觀察及其對(duì)胰高血糖素樣肽1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(6): 466469.
  17. 17. Shin AC, Zheng H, Townsend RL, et al. Mealinduced hormone responses in a rat model of RouxenY gastric bypass surgery [J]. Endocrinology, 2010, 151(4): 15881597.
  18. 18. Laferrère B. Effect of gastric bypass surgery on the incretins [J]. Diabetes Metab, 2009, 35(6 Pt 2): 513517.
  19. 19. Bueter M, Ashrafian H, le Roux CW. Mechanisms of weight loss after gastric bypass and gastric banding [J]. Obes Facts, 2009, 2(5): 325331.
  20. 20. Ursavas A, Ilcol YO, Nalci N, et al. Ghrelin, leptin, adiponectin, and resistin levels in sleep apnea syndrome: Role of obesity [J]. Ann Thorac Med, 2010, 5(3): 161165.
  21. 21. Aguirre V, Stylopoulos N, Grinbaum R, et al. An endoluminal sleeve induces substantial weight loss and normalizes glucose homeostasis in rats with dietinduced obesity [J]. Obesity, 2008, 16(12): 25852592.
  22. 22. AbuJaish W, Rosenthal RJ. Sleeve gastrectomy: a new surgical approach for morbid obesity [J]. Expert Rev Gastroenterol Hepatol, 2010, 4(1): 101119.
  23. 23. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure [J]. Surg Obes Relat Dis, 2009, 5(4): 469475.
  24. 24. Nowak A, Bojanowska E. Effects of peripheral or central GLP1 receptor blockade on leptininduced suppression of appetite [J]. J Physiol Pharmacol, 2008, 59(3): 501510.
  25. 25. Iannelli A, Dainese R, Piche T, et al. Laparoscopic sleeve gastrectomy for morbid obesity [J]. World J Gastroenterol, 2008, 14(6): 821827.