Colquitt J, Clegg A, Loveman E, Royle P, Sidhu M K
University of Southampton, Southampton Health Technology Assessments Centre, Boldrewood, Mailpoint 728, Southampton, Hampshire, UK SO16 7PX.
Cochrane Database Syst Rev. 2005 Oct 19(4):CD003641. doi: 10.1002/14651858.CD003641.pub2.
Obesity is associated with increased morbidity and mortality. Surgery for morbid obesity is considered when other treatments have failed. A number of procedures are available, but the effects of these surgical procedures compared with medical management and with each other are uncertain.
To assess the effects of surgery for morbid obesity.
Studies were obtained from computerized searches of multiple electronic bibliographic databases, supplemented with hand searches of selected journals and consultation with experts in obesity research. Date of the most recent searches: December 2004.
Randomised controlled trials comparing different surgical procedures, and randomised controlled trials and prospective cohort studies comparing surgery with non-surgical management for morbid obesity.
Data were extracted by one reviewer and checked independently by two reviewers. Two reviewers independently assessed trial quality.
Twenty-six trials were included. Two randomised controlled trials and three prospective cohort studies compared surgery with non-surgical management, and 21 randomised controlled trials compared different surgical procedures. The quality of most of the trials was poor; just three trials had adequate allocation concealment. A meta-analysis was not possible due to differences in the surgical procedures performed, measures of weight change and length of follow-up. Compared with conventional management, surgery resulted in greater weight loss (21 kg weight loss at eight years versus weight gain), with improvements in quality of life and comorbidities. Some complications of surgery occurred, such as wound infection. Gastric bypass was associated with greater weight loss, better quality of life and fewer revisions, reoperations and/or conversions than gastroplasty, but had more side-effects. Greater weight loss and fewer side-effects and reoperations occurred with adjustable gastric banding than vertical banded gastroplasty, but laparoscopic vertical banded gastroplasty produced more patients with an excellent or good result and fewer late complications than laparoscopic adjustable silicone gastric banding. Vertical banded gastroplasty was associated with greater weight loss but more vomiting than horizontal gastroplasty. Some postoperative deaths occurred in the studies. Weight loss was similar between open and laparoscopic procedures. Fewer serious complications occurred with laparoscopic surgery, although conversion to open surgery was sometimes required. Most studies found that laparoscopic surgery had a longer operative time. But, it resulted in reduced blood loss and quicker recovery.
AUTHORS' CONCLUSIONS: The limited evidence suggests that surgery is more effective than conventional management for weight loss in morbid obesity. The comparative safety and effectiveness of different surgical procedures is unclear.
肥胖与发病率和死亡率增加相关。当其他治疗方法失败时，考虑进行病态肥胖手术。有多种手术方法可供选择，但与药物治疗相比以及这些手术方法之间的效果尚不确定。
评估病态肥胖手术的效果。
通过对多个电子文献数据库进行计算机检索获取研究，辅以对选定期刊的手工检索以及咨询肥胖研究专家。最近一次检索日期：2004年12月。
比较不同手术方法的随机对照试验，以及比较手术与非手术治疗病态肥胖的随机对照试验和前瞻性队列研究。
由一名审阅者提取数据，并由两名审阅者独立核对。两名审阅者独立评估试验质量。
纳入26项试验。两项随机对照试验和三项前瞻性队列研究比较了手术与非手术治疗，21项随机对照试验比较了不同手术方法。大多数试验质量较差；只有三项试验有充分的分配隐藏。由于所进行的手术方法、体重变化测量和随访时间的差异，无法进行荟萃分析。与传统治疗相比，手术导致体重减轻更多（八年时体重减轻21千克与体重增加相比），生活质量和合并症得到改善。手术出现了一些并发症，如伤口感染。与胃成形术相比，胃旁路手术导致体重减轻更多、生活质量更好，且翻修、再次手术和/或转换手术更少，但副作用更多。与垂直捆绑胃成形术相比，可调节胃束带术导致体重减轻更多、副作用和再次手术更少，但腹腔镜垂直捆绑胃成形术产生的效果优异或良好的患者更多，晚期并发症更少。与水平胃成形术相比，垂直捆绑胃成形术导致体重减轻更多，但呕吐更多。研究中出现了一些术后死亡病例。开放手术和腹腔镜手术的体重减轻相似。腹腔镜手术严重并发症较少，尽管有时需要转换为开放手术。大多数研究发现腹腔镜手术的手术时间更长。但是，它导致失血减少和恢复更快。
有限的证据表明，手术在病态肥胖体重减轻方面比传统治疗更有效。不同手术方法的相对安全性和有效性尚不清楚。
