Ruiz-Tovar Jaime, Oller Inmaculada, Tomas Andres, Llavero Carolina, Arroyo Antonio, Calero Alicia, Martinez-Blasco Amparo, Calpena Rafael
Department of Surgery, General University Hospital Elche, Alicante, Spain.
Am Surg. 2012 Sep;78(9):969-74.
Bariatric surgery has been shown to be effective in achieving and maintaining weight change and reducing obesity-related comorbidities. Recent reports have shown that sleeve gastrectomy could have similar resolution rates of the metabolic syndrome than Roux-Y bypass after a short-term follow-up of 1 year. Most surgeons calibrate the sleeve with 32-Fr to 40-Fr bougies. There is little mid- and long-term information available about the evolution of these comorbidities with this procedure and with calibration of the sleeve with a 50-Fr bougie. A retrospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy, calibrated with a 50-Fr bougie, as bariatric procedure between October 2007 and September 2009 was performed. Mean excessive body mass index loss was 76.9 per cent after 1 year and 79.9 per cent after 2 years. After surgery, 83.3 per cent of patients with Type 2 diabetes mellitus discontinued their hypoglycemic medication at 1 month. All the patients with hypertension discontinued antihypertensive drugs at 6 months. One hundred per cent of patients with hypertriglyceridemia discontinued their hypolipidemic drugs at 3 months. Glucose levels decreased significantly 3 months after surgery (mean reduction of 24.7 mg/dL; 95% confidence interval [CI], 8.8 to 40.7; P = 0.003). Triglyceride levels decreased 3 months after surgery (mean reduction of 54.4 mg/dL; 95% CI, 22.8 to 86.1; P = 0.004). High-density lipoprotein (HDL) cholesterol increased significantly after 12 months (increase of 16.7 mg/dL; 95% CI, 11.7 to 21.7; P < 0.001). The changes observed were maintained 24 months after surgery. Sleeve gastrectomy, calibrated with a 50-Fr bougie, significantly reduced glucose and triglyceride levels and the cardiovascular risk predictor triglyceride/HDL ratio and increased HDL levels after surgery and maintained them under normal ranges for at least 2 years.
减重手术已被证明在实现并维持体重变化以及减少肥胖相关合并症方面有效。最近的报告显示，在1年的短期随访后，袖状胃切除术与Roux-Y胃旁路术相比，代谢综合征的缓解率可能相似。大多数外科医生用32-Fr至40-Fr的探条来校准袖状胃。关于采用该手术以及用50-Fr探条校准袖状胃后这些合并症的中长期演变情况，目前可获得的信息很少。对2007年10月至2009年9月期间所有接受用50-Fr探条校准的腹腔镜袖状胃切除术作为减重手术的病态肥胖患者进行了一项回顾性研究。1年后平均超重体重指数下降了76.9%，2年后下降了79.9%。术后，83.3%的2型糖尿病患者在1个月时停用了降糖药物。所有高血压患者在6个月时停用了降压药。100%的高甘油三酯血症患者在3个月时停用了降脂药物。术后3个月血糖水平显著下降（平均降低24.7 mg/dL；95%置信区间[CI]，8.8至40.7；P = 0.003）。术后3个月甘油三酯水平下降（平均降低54.4 mg/dL；95% CI，2至86.1；P = 0.004）。高密度脂蛋白（HDL）胆固醇在12个月后显著升高（升高16.7 mg/dL；95% CI，11.7至21.7；P < 0.001）。观察到的这些变化在术后24个月时得以维持。用50-Fr探条校准的袖状胃切除术在术后显著降低了血糖和甘油三酯水平以及心血管风险预测指标甘油三酯/HDL比值，并提高了HDL水平，且至少在2年内将它们维持在正常范围内。
