Silecchia Gianfranco, Boru Cristian, Pecchia Alessandro, Rizzello Mario, Casella Giovanni, Leonetti Frida, Basso Nicola
Department of Surgery P. Stefanini, University La Sapienza of Rome, Rome, Italy.
Obes Surg. 2006 Sep;16(9):1138-44. doi: 10.1381/096089206778392275.
We evaluated laparoscopic sleeve gastrectomy (LSG) on major co-morbidities (hypertension, type 2 diabetes / impaired glucose tolerance, obstructive sleep apnea syndrome (OSAS) and on American Society of Anesthesiologists (ASA) operative risk score in high-risk super-obese patients undergoing two-stage laparoscopic biliopancreatic diversion with duodenal switch (LBPD-DS).
41 super-obese high-risk patients (mean BMI 57.3+/-6.5 kg/m(2), age 44.6+/-9.7 years) were entered into a prospective study (BMI > or = 60, or BMI > or = 50 with at least two severe co-morbidities, no Prader-Willi syndrome, no conversion, minimum follow-up 12 months). 9 patients had BMI > or = 60. 17 patients (41.4%) had OSAS on C-PAP therapy. In 10 patients, at least one intragastric balloon had been positioned and 4 had undergone laparoscopic adjustable gastric banding, all with unsatisfactory results. At surgery, 41.5% were classified ASA 4 and 58.5% as ASA 3 (mean ASA score 3.4+/-0.5). Patients underwent evaluation every 3 months postoperatively and were restaged at 12 months and/or before the second step.
60% of major co-morbidities were cured and 24% improved. Average BMI after 6 and 12 months was 44.5+/-8.1 and 40.8+/-8.5 respectively (mean follow-up 22.2+/-7.1 months). After 12 months, 57.8% of the patients were co-morbidity-free and 31.5% had only one major co-morbid condition. At restaging, 20% of patients were still classified as ASA score 4 (OSAS on C-PAP therapy). 3 patients showed BMI <30 and were co-morbidity-free 12 months after LSG.
LSG represents a safe and effective procedure to achieve marked weight loss as well as significant reduction of major obesity-related co-morbidities. The procedure reduced the operative risk (ASA score) in super-obese patients undergoing two-stage LBPD-DS.
我们评估了腹腔镜袖状胃切除术（LSG）对高危超级肥胖患者主要合并症（高血压、2型糖尿病/糖耐量受损、阻塞性睡眠呼吸暂停综合征（OSAS））以及美国麻醉医师协会（ASA）手术风险评分的影响，这些患者正接受两阶段腹腔镜胆胰转流十二指肠转位术（LBPD-DS）。
41例超级肥胖高危患者（平均BMI 57.3±6.5 kg/m²，年龄44.6±9.7岁）进入一项前瞻性研究（BMI≥60，或BMI≥50且至少有两种严重合并症，无普拉德-威利综合征，无中转开腹，最短随访12个月）。9例患者BMI≥60。17例患者（41.4%）接受持续气道正压通气（C-PAP）治疗的OSAS。10例患者曾至少放置过一个胃内球囊，4例接受过腹腔镜可调节胃束带术，结果均不理想。手术时，41.5%的患者被分类为ASA 4级，58.5%为ASA 3级（平均ASA评分3.4±0.5）。患者术后每3个月接受评估，并在12个月和/或第二步手术前重新分期。
60%的主要合并症得到治愈，24%有所改善。6个月和12个月后的平均BMI分别为44.5±8.1和40.8±8.5（平均随访22.2±7.1个月）。12个月后，57.8%的患者无合并症，31.5%仅有一种主要合并症。重新分期时，20%的患者仍被分类为ASA评分4级（接受C-PAP治疗的OSAS）。3例患者BMI<30，且在LSG术后12个月无合并症。
LSG是一种安全有效的手术，可实现显著减重以及显著降低主要的肥胖相关合并症。该手术降低了接受两阶段LBPD-DS的超级肥胖患者的手术风险（ASA评分）。
