Gould Jon C, Garren Michael J, Boll Valerie, Starling James R
Department of Surgery, University of Wisconsin Medical School, Madison, Wis, USA.
Surgery. 2006 Oct;140(4):524-9; discussion 529-31. doi: 10.1016/j.surg.2006.07.002.
Super-super obesity (body mass index [BMI] >/= 60 kg/m(2)) is thought to be a risk factor for complications and mortality in laparoscopic Roux-en-Y gastric bypass. Excess weight loss has been demonstrated to be diminished compared with less obese patients following surgery. However, we hypothesize that super-super obese patients who undergo laparoscopic gastric bypass can realize major improvements in their health and a good quality of life without a significantly increased risk of complications when compared with less obese patients.
From July 2002 to July 2005, University of Wisconsin Health bariatric surgeons performed 288 consecutive laparoscopic Roux-en-Y gastric bypass procedures. Patients were divided into 2 groups: BMI >/= 60 kg/m(2) (n = 28) and BMI < 60 kg/m(2) (n = 260). The groups were compared at defined time intervals during a 2-year period following surgery. Comparison criteria included complications, weight loss, comorbidities, and quality of life.
Both groups had similar morbidity and mortality rates. Excess weight loss was shown to be less, but total pounds lost were greater, for the super-super obese patients at all postoperative time intervals specified for postoperative analysis. Despite this fact, overall health improved to a similar degree in each group of patients following surgery; both groups also had similar Moorehead-Ardelt quality of life scores. Using the Bariatric Analysis and Reporting Outcome System (BAROS) to categorize outcomes, the average result for a patient in either group of patients would be considered "very good" at 1 year following surgery.
Laparoscopic Roux-en-Y gastric bypass can be accomplished safely even in extremely obese patients. Although excess weight loss in the super-super obese is diminished postoperatively when compared with less obese patients, health is improved and quality of life is good regardless of a patient's preoperative BMI. Therefore, laparoscopic gastric bypass is a good option even in the extremely obese.
超超级肥胖（体重指数[BMI]≥60kg/m²）被认为是腹腔镜Roux-en-Y胃旁路手术并发症和死亡率的危险因素。与肥胖程度较低的患者相比，术后超重减轻情况已被证实有所减少。然而，我们推测，接受腹腔镜胃旁路手术的超超级肥胖患者与肥胖程度较低的患者相比，在不显著增加并发症风险的情况下，其健康状况能实现重大改善且生活质量良好。
2002年7月至2005年7月，威斯康星大学健康中心的减重外科医生连续进行了288例腹腔镜Roux-en-Y胃旁路手术。患者分为两组：BMI≥60kg/m²（n = 28）和BMI＜60kg/m²（n = 260）。在术后2年的特定时间间隔对两组进行比较。比较标准包括并发症、体重减轻、合并症和生活质量。
两组的发病率和死亡率相似。在术后分析指定的所有术后时间间隔，超超级肥胖患者的超重减轻较少，但总体减重更多。尽管如此，每组患者术后总体健康状况改善程度相似；两组的穆尔黑德-阿德尔特生活质量评分也相似。使用减重分析和报告结果系统（BAROS）对结果进行分类，术后1年两组中任一患者的平均结果都将被视为“非常好”。
即使是极度肥胖患者，腹腔镜Roux-en-Y胃旁路手术也能安全完成。尽管与肥胖程度较低的患者相比，超超级肥胖患者术后超重减轻有所减少，但无论患者术前BMI如何，健康状况均得到改善且生活质量良好。因此，即使是极度肥胖患者，腹腔镜胃旁路手术也是一个不错的选择。
