腹腔镜可调节胃束带术后4年共病情况的改善

Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding.

作者信息

Frigg Arno, Peterli Ralph, Peters Thomas, Ackermann Christoph, Tondelli Peter

机构信息

Surgical Clinic, St Claraspital, Basel, Switzerland.

出版信息

Obes Surg. 2004 Feb;14(2):216-23. doi: 10.1381/096089204322857591.

DOI:10.1381/096089204322857591

PMID:15018751

Abstract

BACKGROUND

We investigated the reduction in co-morbidities following laparoscopic adjustable silicone gastric banding (LAGB).

METHODS

Between December 1996 and October 2002, 295 patients with mean BMI 45 kg/m(2) were operated (79% women, average age 41 years). Mean follow-up was 44 months. Reduction in co-morbidity was scaled relative to the preoperative co-morbidity level as having been cured, improved, unchanged, or worsened. Patients needing reoperations were analyzed separately.

RESULTS

The preoperative frequencies of co-morbidities were as follows: hypertension 52%, diabetes 20%, dyspnea 85%, peripheral edema 63%, sleep apnea 36%, arthralgia 89%, reflux 57%, reduced self-esteem 95%, reduced general physical performance 96%, hyperlipidemia 39%, hyperuricemia 36%, and menstrual problems 22%. Excess weight loss after 1 year was 40%, after 2 years 46%, after 3 years 47%, and after 4 years 54%. After 4 years, the rate of cure/improvement of the co-morbiditites were: hypertension 58% / 42%, diabetes 75% / 8%, dyspnea 85% / 12%, arthralgia 52% / 24%, reflux 79% / 11%, self-esteem 45% / 39%, and general physical performance 58% / 33%. We also found an improvement in stress incontinence, sleep apnea, peripheral edema, and regulation of menstruation. Greater weight loss was associated with greater reduction in dyspnea, arthralgia, self-esteem, and physical performance. Hypertension, diabetes, reflux, and edema improved independent of the amount of weight loss. Reoperated patients undergoing either rebanding or biliopancreatic diversion with duodenal switch had similar weight loss and reduction in co-morbidities as did patients treated with LAGB only.

CONCLUSION

With moderate weight loss following LAGB, co-morbidities were cured in 50-80% or improved in 10-40% of all patients.

摘要

背景

我们研究了腹腔镜可调节硅胶胃束带术（LAGB）后合并症的减少情况。

方法

在1996年12月至2002年10月期间，对295例平均体重指数为45kg/m²的患者进行了手术（79%为女性，平均年龄41岁）。平均随访时间为44个月。合并症的减少根据术前合并症水平按治愈、改善、未改变或恶化进行分级。对需要再次手术的患者进行单独分析。

结果

术前合并症的发生率如下：高血压52%，糖尿病20%，呼吸困难85%，外周水肿63%，睡眠呼吸暂停36%，关节痛89%，反流57%，自尊降低95%，总体身体机能下降96%，高脂血症39%，高尿酸血症36%，月经问题22%。1年后体重减轻40%，2年后46%，3年后47%，4年后54%。4年后，合并症的治愈/改善率分别为：高血压58% / 42%，糖尿病75% / 8%，呼吸困难85% / 12%，关节痛52% / 24%，反流79% / 11%，自尊45% / 39%，总体身体机能58% / 33%。我们还发现压力性尿失禁、睡眠呼吸暂停、外周水肿和月经调节有所改善。体重减轻越多，呼吸困难、关节痛、自尊和身体机能的改善就越明显。高血压、糖尿病、反流和水肿的改善与体重减轻量无关。接受再次束带术或十二指肠转位的胆胰分流术的再次手术患者，其体重减轻和合并症减少情况与仅接受LAGB治疗的患者相似。