تأثير آناستوموز گاستروژوژنوستومي با دو قطر 03 و 54 ميلي متر در عمل جراحي ميني باي پس معده بر تغييرات وزن بيماران دچار چاقي مفرط: يك مطالعه ي كارآزمايي باليني

The Effect of Anastomosis Gastro-Jejunostomy with Two Diameters of 30 and 45 mm on Mini-Gastric Bypass Surgery on Weight Changes in Obese Patients: A Clinical Trial Study

ﻣﻘﺪﻣﻪ: ﭼﺎﻗﯽ از ﻣﺸﮑﻼت ﺷﺎﯾﻊ ﺟﻮاﻣﻊ ﺑﺸﺮي در ﻋﺼﺮ ﺣﺎﺿﺮ ﻣﯽ ﺑﺎﺷﺪ. اﺳﺘﻔﺎده از روش ﻫﺎي ﻣﺨﺘﻠﻒ ﺟﺮاﺣﯽ ﺑﺎرﯾﺎﺗﺮﯾﮏ، ﺑﻪ ﻃﻮر وﺳﯿﻊ ﺟﻬﺖ درﻣﺎن آن ﺑﻪ ﮐﺎر ﮔﺮﻓﺘﻪ ﻣﯽ ﺷﻮد. اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﺑﺎ ﻫﺪف ﻣﻘﺎﯾﺴﻪ ي ﻣﯿﺰان ﮐﺎﻫﺶ وزن و ﻧﻤﺎﯾﻪ ي ﺗﻮده ي ﺑﺪﻧﯽ در ﺑﯿﻤﺎران ﭼﺎﻗﯽ ﻣﻔﺮط ﮐﺎﻧﺪﯾﺪاي ﺟﺮاﺣﯽ ﺑﺎرﯾﺎﺗﺮﯾﮏ ﺑﻪ روش SAGB) Single anastomosis gastric bypass( ﺑﺎ آﻧﺎﺳﺘﻮﻣﻮز ﮔﺎﺳﺘﺮوژژﻧﻮﺳﺘﻮﻣﯽ ﺑﺎ اﺳﺘﺎﭘﻠﺮ ﺧﻄﯽ 3/5 ﺑﺎ ﻃﻮل 30 و 45 ﻣﯿﻠﯽ ﻣﺘﺮ اﻧﺠﺎم ﮔﺮﻓﺖ. روش ﻫﺎ: در ﯾﮏ ﻣﻄﺎﻟﻌﻪ ي ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ ﺗﺼﺎدﻓﯽ در ﺳﺎل 1398 در ﺑﯿﻤﺎرﺳﺘﺎن ﻫﺎي اﻟﺰﻫﺮا )س( و آﯾﺖ اﻟﻪ ﮐﺎﺷﺎﻧﯽ اﺻﻔﻬﺎن، 80 ﺑﯿﻤﺎر ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﯽ ﺑﺎي ﭘﺲ ﻣﻌﺪه ﺑﺎ آﻧﺎﺳﺘﻮﻣﻮز ﮔﺎﺳﺘﺮوژژﻧﻮﺳﺘﻮﻣﯽ ﺑﺎ اﺳﺘﺎﭘﻠﺮ ﺧﻄﯽ ﺑﺮﺷﯽ، در دو ﮔﺮوه 40 ﻧﻔﺮه ﺗﻮزﯾﻊ ﺷﺪﻧﺪ. در ﮔﺮوه اول، ﮔﺎﺳﺘﺮوژژﻧﻮﺳﺘﻮﻣﯽ اﯾﺠﺎد ﺷﺪه ﺑﺎ اﺳﺘﺎﭘﻠﺮ ﺧﻄﯽ ﺑﺮﺷﯽ ﺑﺎ ﻗﻄﺮ 3/5 × 30 و در ﮔﺮوه دوم ﺑﺎ ﻗﻄﺮ 3/5 × 45 ﻣﯿﻠﯽ ﻣﺘﺮ اﻧﺠﺎم ﮔﺮدﯾﺪ. ﺑﯿﻤﺎران در 6 ﻣﺎه ﺑﻌﺪ از ﻋﻤﻞ، ﺗﺤﺖ ﭘﯽ ﮔﯿﺮي ﻗﺮار ﮔﺮﻓﺘﻨﺪ و ﻣﯿﺰان ﮐﺎﻫﺶ وزن و ﮐﺎﻫﺶ ﻧﻤﺎﯾﻪ ي ﺗﻮده ي ﺑﺪﻧﯽ در دو ﮔﺮوه ﺗﻌﯿﯿﻦ و ﻣﻘﺎﯾﺴﻪ ﮔﺮدﯾﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ ﮐﺎﻫﺶ ﻧﻤﺎﯾﻪ ي ﺗﻮده ي ﺑﺪﻧﯽ در ﮔﺮوه ﺗﺤﺖ ﻋﻤﻞ ﮔﺎﺳﺘﺮوژژﻧﻮﺳﺘﻮﻣﯽ ﺑﺎ اﺳﺘﺎﭘﻠﺮ ﺧﻄﯽ ﺑﺮﺷﯽ ﺑﺎ ﻗﻄﺮﻫﺎي 3/5 × 30 و 3/5 × 45 ﻣﯿﻠﯽ ﻣﺘﺮ ﺑﻪ ﺗﺮﺗﯿﺐ 4/79 ± 12/79 و 5/37 ± 12/37 ﮐﯿﻠﻮﮔﺮم/ﻣﺘﺮﻣﺮﺑﻊ ﺑﻮد و ﺗﻔﺎوت ﻣﻌﻨﯽ داري در ﻫﺮ دو ﮔﺮوه دﯾﺪه ﺷﺪ )0/001 < P(، اﻣﺎ اﺧﺘﻼف ﺑﯿﻦ دو ﮔﺮوه، ﻣﻌﻨﯽ دار ﻧﺒﻮد )0/710 = P(. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: ﻧﺘﺎﯾﺞ ﻣﻄﺎﻟﻌﻪ ي ﺣﺎﺿﺮ ﻧﺸﺎن داد آﻧﺎﺳﺘﻮﻣﻮز ﮔﺎﺳﺘﺮوژژوﻧﻮﺳﺘﻮﻣﯽ ﺑﺎ ﻫﺮ دو ﻗﻄﺮ 30 و 45 ﻣﯿﻠﯽ ﻣﺘﺮ ﺑﺎﻋﺚ ﮐﺎﻫﺶ وزن ﺑﯿﻤﺎران در ﻃﯽ ﺷﺶ ﻣﺎه ﺑﻌﺪ از ﻋﻤﻞ ﻣﯽ ﺷﻮد و ﺗﻔﺎوﺗﯽ ﺑﯿﻦ اﯾﻦ دو ﻗﻄﺮ آﻧﺎﺳﺘﻮﻣﻮز وﺟﻮد ﻧﺪارد.

Background: Obesity is one of the most common problems in community. Bariatric surgery is widely used to treat obesity. The aim of this study was compare the weight loss and body mass index (BMI) in obese patients undergoing single bariatric surgery with Single anastomosis gastric bypass (SAGB) with 3.5 mm linear stapler anastomosis with 30 mm and 45 mm diameters. Methods: In a randomized clinical trial study in 2019 in Alzahra and Kashani hospitals in Isfahan, Iran, 80 patients undergoing gastric bypass surgery with an anastomosis with gastrojejunostomy with linear shear stapler were divided into two groups of 40. The first group underwent SAGB surgery with 30 mm for their diameter of gastrojejunostomy anastomosis, and in the second group, this diameter was considered 40 mm. Patients were followed for 6 months after surgery, and the amount of weight loss and BMI changes were determined and compared in two groups. Findings: The mean decrease of BMI in gastrojejunostomy diameter of 30 and 45 millimeters was 12.79 ± 4.79 and 12.37 ± 5.37 kg/m2, and the decrease of BMI was significant in both groups (P < 0.001), but no significant difference were seen between the two groups (P = 0.71). Conclusion: The results show that gastroesophageal anastomosis with both diameters of 30 and 45 mm reduce the weight of patients during the next six months of operation, and there is no difference between these two diameters of anastomosis.