Gutschow Christian A, Collet Peter, Prenzel Klaus, Hölscher Arnulf H, Schneider Paul M
Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
J Gastrointest Surg. 2005 Sep-Oct;9(7):941-8. doi: 10.1016/j.gassur.2005.02.001.
During the past decade, laparoscopic adjustable gastric banding has become the most popular surgical procedure in treating morbid obesity. On the other hand, significant drawbacks such as inadequate long-term weight loss, a high prevalence of reoperations, and frequent postoperative symptoms have been reported in the literature. This analysis summarizes our Department's experience with this operation. Thirty-one patients (27 women and 4 men) with a mean body mass index of 46.5 kg/m(2) (range, 38.3-59.8 kg/m(2)) were operated upon laparoscopically between September 1997 and January 2003. The preoperative work-up of all patients included a psychological evaluation. Mean follow-up was 59.3 months (range, 19-84 months). Sixteen patients had esophageal pH-metry and 18 patients had upper gastrointestinal endoscopy preoperatively and postoperatively. Data were collected prospectively during the outpatient visits. Mean preoperative excess weight was 65.6 kg (range, 37.4-96.1 kg). Mean excess weight loss after 12, 24, 36, 48, 60, 72, and 84 months was 40.3%, 50.5%, 51.9%, 48.9%, 46.2%, 51.8%, and 30.2%, respectively. In total, six patients (19.4%) had an abdominal reoperation, including four patients (12.9%) for band removal. Upper gastrointestinal endoscopy was performed in 18 patients after 30.1 months (range, 5-67 months), showing a high prevalence of esophagitis (30.0%; grade 1: n=3, grade 2: n=3). Conversely, postoperative esophageal pH-metry performed in 16 patients was pathologic in 43.8%. Laparoscopic adjustable gastric banding produces significant weight loss even after long-term follow-up. However, the reoperation rate is high and postoperative symptoms are frequent. The high incidence of gastroesophageal reflux and esophagitis remains a matter of concern.
在过去十年中，腹腔镜可调节胃束带术已成为治疗病态肥胖最常用的外科手术。另一方面，文献报道了一些显著的缺点，如长期体重减轻不足、再次手术发生率高以及术后症状频繁。本分析总结了我们科室开展该手术的经验。1997年9月至2003年1月期间，对31例患者（27例女性和4例男性）进行了腹腔镜手术，平均体重指数为46.5kg/m²（范围为38.3 - 59.8kg/m²）。所有患者术前均进行了心理评估。平均随访时间为59.3个月（范围为19 - 84个月）。16例患者进行了食管pH值测定，18例患者术前和术后进行了上消化道内镜检查。数据在门诊随访期间前瞻性收集。术前平均超重65.6kg（范围为37.4 - 96.1kg）。术后12、24、36、48、60、72和84个月时，平均超重减轻分别为40.3%、50.5%、51.9%、48.9%、46.2%、51.8%和30.2%。共有6例患者（19.4%）进行了腹部再次手术，其中4例患者（12.9%）进行了束带拆除。18例患者在30.1个月（范围为5 - 67个月）后进行了上消化道内镜检查，食管炎发生率较高（30.0%；1级：n = 3，2级：n = 3）。相反，16例患者术后进行的食管pH值测定结果显示，43.8%为病理性。即使经过长期随访，腹腔镜可调节胃束带术仍能显著减轻体重。然而，再次手术率较高，术后症状频繁。胃食管反流和食管炎的高发生率仍然令人担忧。
