腹腔镜Roux-en-Y胃旁路术与迷你胃旁路术治疗病态肥胖症：一项前瞻性随机对照临床试验
Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial.
作者信息
Lee Wei-Jei, Yu Po-Jui, Wang Weu, Chen Tai-Chi, Wei Po-Li, Huang Ming-Te
机构信息
Department of Surgery, En-Chu Kong Hospital and School of Nursing, Taiwan.
出版信息
Ann Surg. 2005 Jul;242(1):20-8. doi: 10.1097/01.sla.0000167762.46568.98.
OBJECTIVES
This prospective, randomized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic mini-gastric bypass (LMGBP) in the treatment of morbid obesity.
SUMMARY BACKGROUND DATA
LRYGBP has been the gold standard for the treatment of morbid obesity. While LMGBP has been reported to be a simple and effective treatment, data from a randomized trial are lacking.
METHODS
Eighty patients who met the NIH criteria were recruited and randomized to receive either LRYGBP (n = 40) or LMGBP (n = 40). The minimum postoperative follow-up was 2 years (mean, 31.3 months). Perioperative data were assessed. Late complication, excess weight loss, BMI, quality of life, and comorbidities were determined. Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index (GIQLI).
RESULTS
There was one conversion (2.5%) in the LRYGBP group. Operation time was shorter in LMGBP group (205 versus 148, P < 0.05). There was no mortality in each group. The operative morbidity rate was higher in the LRYGBP group (20% versus 7.5%, P < 0.05). The late complications rate was the same in the 2 groups (7.5%) with no reoperation. The percentage of excess weight loss was 58.7% and 60.0% at 1 and 2 years, respectively, in the LPYGBP group, and 64.9% and 64.4% in the LMGBP group. The residual excess weight <50% at 2 years postoperatively was achieved in 75% of patients in the LRYGBP group and 95% in the LMGBP group (P < 0.05). A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted. Both gastrointestinal quality of life increased significantly without any significant difference between the groups.
CONCLUSION
Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.
目的
这项前瞻性随机试验比较了腹腔镜Roux-en-Y胃旁路术（LRYGBP）和腹腔镜迷你胃旁路术（LMGBP）治疗病态肥胖的安全性和有效性。
总结背景数据
LRYGBP一直是治疗病态肥胖的金标准。虽然已有报道称LMGBP是一种简单有效的治疗方法，但缺乏随机试验的数据。
方法
招募了80名符合美国国立卫生研究院（NIH）标准的患者，并随机分为接受LRYGBP组（n = 40）或LMGBP组（n = 40）。术后最短随访时间为2年（平均31.3个月）。评估围手术期数据。确定晚期并发症、超重减轻情况、体重指数（BMI）、生活质量和合并症。使用胃肠道生活质量指数（GIQLI）评估生活质量的变化。
结果
LRYGBP组有1例中转手术（2.5%）。LMGBP组手术时间较短（205分钟对148分钟，P < 0.05）。每组均无死亡病例。LRYGBP组手术发病率较高（20%对7.5%，P < 0.05）。两组晚期并发症发生率相同（7.5%），均未再次手术。LRYGBP组在1年和2年时超重减轻百分比分别为58.7%和60.0%，LMGBP组分别为64.9%和64.4%。术后2年时，LRYGBP组75%的患者残余超重<50%，LMGBP组为95%（P < 0.05）。两组肥胖相关临床参数均有显著改善，代谢综合征完全缓解。两组胃肠道生活质量均显著提高，组间无显著差异。
结论
LRYGBP和LMGBP对病态肥胖均有效，在代谢综合征缓解和生活质量改善方面结果相似。LMGBP是一种更简单、更安全的手术方法，在2年随访时与LRYGBP相比没有劣势。
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