Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France.
Surg Obes Relat Dis. 2012 May-Jun;8(3):250-4. doi: 10.1016/j.soard.2011.05.012. Epub 2011 Jun 2.
Since the introduction of the isolated sleeve gastrectomy in 1997, this procedure has gained immense popularity in the hopes of reducing the operative risks with a less complex operation. We reviewed our recent 2-year experience with bariatric surgery to compare the early outcomes of the 3 complex procedures routinely performed by our private practice at a single institution: sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (BPD-DS).
The 30-day morbidity and 90-day mortality rates were retrospectively reviewed among a total of 507 primary bariatric procedures. The early postoperative outcomes of 360 RYGB, 88 SG, and 59 BPD-DS procedures performed during this period were compared.
The patients weighed more in the BPD-DS and SG groups. The SG patients were significantly older than the RYGB and BPD-DS patients. Co-morbidities were significantly more frequent in the SG and BPD-DS patients. One patient died after RYGB but none did so after BPD-DS or SG. The global complication rate was significantly increased after BPD-DS (P = .0017) compared with RYGB; however, no difference was found between RYGB and SG, although bleeding was likely to appear more frequent, not only after BPD-DS, but also after SG compared with RYGB.
Although no fatal outcomes occurred after SG, this procedure did not demonstrate a reduced risk of postoperative complications compared with RYGB with a significantly greater rate of bleeding. RYGB appears to be a relatively safe bariatric procedure, although the groups were not comparable in terms of the preoperative body mass index or co-morbidities, the exact role of which on postoperative morbidity remains controversial. Although the increased risk of RYGB to BPD-DS was confirmed, SG failed to live up to its "more benign" reputation.
自 1997 年引入袖状胃切除术以来，由于手术风险较低，操作相对简单，该术式在减重与代谢手术领域得到了广泛应用。本研究回顾了近 2 年来我们的减重与代谢手术经验，旨在比较我院普外科团队常规开展的 3 种术式（袖状胃切除术、胃旁路术和胆胰分流十二指肠转位术）的早期疗效。
我们回顾性分析了 507 例初次接受减重与代谢手术患者的围手术期资料，包括 30 天并发症发生率和 90 天死亡率。对比分析了同期实施的 360 例胃旁路术、88 例袖状胃切除术和 59 例胆胰分流十二指肠转位术患者的早期疗效。
胆胰分流十二指肠转位术组和袖状胃切除术组患者的体重指数更高，袖状胃切除术组患者的年龄显著大于胃旁路术和胆胰分流十二指肠转位术组患者。袖状胃切除术和胆胰分流十二指肠转位术组患者的合并症更为常见。胃旁路术组患者术后出现 1 例死亡，但胆胰分流十二指肠转位术和袖状胃切除术组均未出现死亡病例。胆胰分流十二指肠转位术组患者的总并发症发生率显著高于胃旁路术组（P =.0017），但胃旁路术组与袖状胃切除术组之间无显著差异，虽然胃旁路术组和袖状胃切除术组均存在出血风险，但与胃旁路术组相比，胆胰分流十二指肠转位术组和袖状胃切除术组的出血风险可能更高。
虽然袖状胃切除术组患者术后无死亡病例，但与胃旁路术相比，该术式并未降低术后并发症风险，且出血并发症更为常见。胃旁路术是一种相对安全的减重与代谢手术，但由于术前体重指数和合并症两组间不可比，其对术后发病率的确切作用仍存在争议。虽然本研究证实胃旁路术的并发症发生率高于胆胰分流十二指肠转位术，但袖状胃切除术也未能如其“更为良性”的名声一样，降低手术风险。
