Prachand Vivek N, Davee Roy T, Alverdy John C
University of Chicago, Chicago, IL 60637, USA.
Ann Surg. 2006 Oct;244(4):611-9. doi: 10.1097/01.sla.0000239086.30518.2a.
Although weight loss following Roux-en-Y gastric bypass is acceptable in patients with preoperative body mass index (BMI) between 35 and 50 kg/m, results from several series demonstrate that failure rates approach 40% when BMI is > or =50 kg/m. Here we report the first large single institution series directly comparing weight-loss outcomes in super-obese patients following biliopancreatic diversion with duodenal switch (DS) and Roux-en-Y Gastric Bypass (RYGB).
All super-obese patients (BMI > or =50 kg/m) undergoing standardized laparoscopic and open DS and RYGB between August 2002 and October 2005 were identified from a prospective database. Two-sample t tests were used to compare weight loss, decrease in BMI, and percentage of excess body weight loss (% EBWL) after surgery. chi analysis was used to determine the rate of successful weight loss, defined as achieving at least 50% loss of excess body weight.
A total of 350 super-obese patients underwent DS (n = 198) or RYGB (n = 152) with equal 30-day mortality (DS,1 of 198; RYGB, 0 of 152; P = not significant). The % EBWL at follow-up was greater for DS than RY (12 months, 64.1% vs. 55.9%; 18 months, 71. 9% vs. 62.8%; 24 months, 71.6% vs. 60.1%; 36 months, 68.9% vs. 54.9%; P < 0.05). Total weight loss and decrease in BMI were also statistically greater for the DS (data not shown). Importantly, the likelihood of successful weight loss (EBWL >50%) was significantly greater in patients following DS (12 months, 83.9% vs. 70.4%; 18 months, 90.3% vs. 75.9%; 36 months, 84.2% vs. 59.3%; P < 0.05).
Direct comparison of DS to RYGB demonstrates superior weight loss outcomes for DS.
尽管对于术前体重指数（BMI）在35至50kg/m²之间的患者，Roux-en-Y胃旁路术后的体重减轻情况尚可，但多个系列研究结果表明，当BMI≥50kg/m²时，失败率接近40%。在此，我们报告首个大型单机构系列研究，直接比较了胆胰转流十二指肠转位术（DS）和Roux-en-Y胃旁路术（RYGB）对超级肥胖患者体重减轻效果的影响。
从一个前瞻性数据库中确定了2002年8月至2005年10月期间接受标准化腹腔镜和开放DS及RYGB手术的所有超级肥胖患者（BMI≥50kg/m²）。采用双样本t检验比较术后体重减轻、BMI降低以及多余体重减轻百分比（%EBWL）。使用卡方分析确定成功减重率，成功减重定义为多余体重减轻至少50%。
共有350例超级肥胖患者接受了DS（n = 198）或RYGB（n = 152）手术，30天死亡率相同（DS组198例中有1例死亡；RYGB组152例中无死亡；P值无统计学意义）。随访时DS组的%EBWL高于RYGB组（12个月时，64.1%对55.9%；18个月时，71.9%对62.8%；24个月时，71.6%对60.1%；36个月时，68.9%对54.9%；P < 0.05）。DS组的总体体重减轻和BMI降低在统计学上也更显著（数据未显示）。重要的是，DS术后患者成功减重（EBWL>50%）的可能性显著更高（12个月时，83.9%对70.4%；18个月时，90.3%对75.9%；36个月时，84.2%对59.3%；P < 0.05）。
DS与RYGB的直接比较表明，DS的体重减轻效果更佳。
