Näslund E, Freedman J, Lagergren J, Stockeld D, Granström L
Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Obes Surg. 1999 Aug;9(4):369-73. doi: 10.1381/096089299765552954.
Despite the development of pharmacologic agents for the treatment of massive obesity, surgery remains the only treatment option that has been shown to offer long-term weight reduction. Laparoscopic surgery appears to offer rapid recovery and low postoperative morbidity. The aim of the present study was to assess the outcome of laparoscopic vertical banded gastroplasty (lap VBG) in 60 obese patients.
60 massively obese patients (50 female) with a mean +/- SEM body mass index (BMI) of 44.4 +/- 1.0 kg/m2 were followed up prospectively for an average of 23.0 +/- 1.5 months. Lap VBG was performed using 5 trocars placed in a standard fashion for laparoscopic upper gastrointestinal surgery. A 4-row stapler was used for the vertical staple-line, and a stretched polytetrafluoroethylene (Gore-Tex) band was used to reinforce the outlet. The patients were seen postoperatively 2, 6, 12, 24, and 36 months after surgery.
Conversion to open surgery was performed in 15 cases. Preoperative median BMI and postoperative hospital stay were higher in the open group than in the laparoscopic group: 47.8 kg/m2 (37.7-65.7) and 5 days (3-13), and 41.9 kg/m2 (32.5-57.3) and 3 days (2-6), respectively (P < 0.01 for both). After 36 months of follow-up, the median BMI was 36.9 kg/m2 (24.6-50.7) (n = 9) in the open group and 37.0 kg/m2 (25.8-53.3) (n = 14) (NS) in the laparoscopic group. The number of conversions to open surgery and the median operating time were higher in the first 30 cases than in the last 30 cases: 11 and 137.5 min (96-225) and 4 and 115.0 min (85-190), respectively, with similar preoperative BMI: 44.1 kg/m2 (33.8-65.8) and 41.2 kg/m2 (32.4-57.8).
Lap VBG can be performed safely and results in a shorter postoperative stay than does open surgery. Weight loss was maintained over the 3-year follow-up period. There is a learning curve, resulting in fewer conversions to open surgery and shorter operating time. Long follow-up studies are needed to ascertain that long-term weight loss equals that of open VBG.
尽管已开发出用于治疗重度肥胖的药物，但手术仍是唯一被证明能实现长期体重减轻的治疗选择。腹腔镜手术似乎能实现快速康复且术后发病率较低。本研究的目的是评估60例肥胖患者接受腹腔镜垂直束带胃成形术（lap VBG）的效果。
60例重度肥胖患者（50例女性），平均±标准误体重指数（BMI）为44.4±1.0kg/m²，进行前瞻性随访，平均随访时间为23.0±1.5个月。lap VBG采用5个套管针以腹腔镜上消化道手术的标准方式置入。使用4排吻合器进行垂直吻合线操作，并使用拉伸聚四氟乙烯（戈尔特斯）束带加强出口。术后分别在术后2、6、12、24和36个月对患者进行观察。
15例患者转为开腹手术。开腹组术前中位BMI和术后住院时间均高于腹腔镜组：分别为47.8kg/m²（37.7 - 65.7）和5天（3 - 13），以及41.9kg/m²（32.5 - 57.3）和3天（2 - 6）（两者P均<0.01）。随访36个月后，开腹组中位BMI为36.9kg/m²（24.6 - 50.7）（n = 9），腹腔镜组为37.0kg/m²（25.8 - 53.3）（n = 14）（无显著性差异）。前30例患者转为开腹手术的例数和中位手术时间高于后30例：分别为11例和137.5分钟（96 - 225）以及4例和115.0分钟（85 - 190），术前BMI相似：分别为44.1kg/m²（33.8 - 65.8）和41.2kg/m²（32.4 - 57.8）。
lap VBG可安全实施，且术后住院时间比开腹手术短。在3年随访期内体重减轻得以维持。存在学习曲线，导致转为开腹手术的例数减少且手术时间缩短。需要进行长期随访研究以确定长期体重减轻情况是否与开腹VBG相当。
