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[梅森垂直胃成形术治疗病态肥胖症。一项前瞻性临床研究的结果]

[Mason vertical gastroplasty in treatment of morbid obesity. Results of a prospective clinical study].

作者信息

Naef M, Sadowski C, de Marco D, Sabbioni M, Balsiger B, Laederach K, Bürgi U, Büchler M W

机构信息

Klinik für Viszerale und Transplantationschirurgie, Inselspital Bern, Schweiz.

出版信息

Chirurg. 2000 Apr;71(4):448-55. doi: 10.1007/s001040051081.

Abstract

Morbid obesity (body mass index > 40 kg/m2) is a risk factor for cardiovascular, pulmonary, metabolic, neoplastic, and psychologic sequelae. In the present prospective clinical study 65 patients (11 men, 54 women) underwent vertical banded gastroplasty (Mason procedure) from June 1994 to October 1997. The median age was 41 +/- 5.3 years (range 18-69; n = 65). Preoperative body weight was 135 +/- 23 kg (96-229; n = 65), excess body weight in kg was 75 +/- 6.9 (44-155; n = 65) or in % 126 +/- 10 (78-223; n = 65) and BMI was 49 +/- 7.4 kg/m2 (39-69; n = 65). Mean hospital stay was 9.7 +/- 2.4 days (6-18; n = 65). Hospital mortality was 0% (0/65). Early complications were vomiting (30%) and problems in wound healing (15%; n = 65). Late complications (> 30 days) were incisional hernias (13.8%) and staple-line disruptions (12.3%; n = 65) with a reoperation rate of 23% (15/65). Median follow-up was 15.0 +/- 5.2 months (2-42) with a follow up rate of 100%. Mean weight loss after 12 months was 38.5 +/- 17 kg (30-98; n = 34) (P < 0.0001) and loss of excessive body weight 65 +/- 10% (57-86; n = 34), respectively (P < 0.0001). Cardiovascular risk factors (hypertension, diabetes, hyperlipidemia) were significantly improved within 12 months (n = 34). Vertical banded gastroplasty (Mason procedure)--well established for 20 years--is a good, safe therapy for morbid obesity if strict indications for operation are observed and if there is multidisciplinary long-term follow-up. Comorbid risk factors are considerably reduced and a long-term weight loss of more than 50% can be achieved without the risk of pathological metabolic changes.

摘要

病态肥胖(体重指数>40kg/m²)是心血管、肺部、代谢、肿瘤及心理后遗症的一个危险因素。在本前瞻性临床研究中,1994年6月至1997年10月期间,65例患者(11例男性,54例女性)接受了垂直捆扎胃成形术(梅森手术)。中位年龄为41±5.3岁(范围18 - 69岁;n = 65)。术前体重为135±23kg(96 - 229kg;n = 65),超重体重以千克计为75±6.9kg(44 - 155kg;n = 65)或以百分比计为126±10%(78 - 223%;n = 65),体重指数为49±7.4kg/m²(39 - 69kg/m²;n = 65)。平均住院时间为9.7±2.4天(6 - 18天;n = 65)。医院死亡率为0%(0/65)。早期并发症为呕吐(30%)和伤口愈合问题(15%;n = 65)。晚期并发症(>30天)为切口疝(13.8%)和吻合钉线断裂(12.3%;n = 65),再次手术率为23%(15/65)。中位随访时间为15.0±5.2个月(2 - 42个月),随访率为100%。12个月后的平均体重减轻为38.5±17kg(30 - 98kg;n = 34)(P < 0.0001),超重体重减轻分别为65±10%(57 - 86%;n = 34)(P < 0.0001)。心血管危险因素(高血压、糖尿病、高脂血症)在12个月内显著改善(n = 34)。垂直捆扎胃成形术(梅森手术)已确立20年,如果严格遵守手术指征并进行多学科长期随访,是一种治疗病态肥胖的良好、安全的疗法。合并的危险因素会大幅降低,可实现超过50%的长期体重减轻,且无病理性代谢变化的风险。

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