腹腔镜 Roux-en-Y 与迷你胃旁路术治疗病态肥胖：10 年经验。
Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience.
机构信息
Department of Surgery, Min-Sheng General Hospital, National Taiwan University, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China.
出版信息
Obes Surg. 2012 Dec;22(12):1827-34. doi: 10.1007/s11695-012-0726-9.
BACKGROUND
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for the treatment of morbid obesity but is technically challenging and results in significant perioperative complications. While laparoscopic mini-gastric bypass (LMGB) has been reported to be a simple and effective treatment for morbid obesity, controversy exists. Long-term follow-up data from a large number of patients comparing LMGB to LRYGB are lacking.
METHODS
Between October 2001 and September 2010, 1,657 patients who received gastric bypass surgery (1,163 for LMGB and 494 for LRYGB) for their morbid obesity were recruited from our comprehensive obesity surgery center. Patients who received revision surgeries were excluded. Minimum follow-up was 1 year (mean 5.6 years, from 1 to 10 years). The operative time, estimated blood loss, length of hospital stay, and operative complications were assessed. Late complication, changes in body weight loss, BMI, quality of life, and comorbidities were determined at follow-up. Changes in quality of life were assessed using the Gastrointestinal Quality of Life Index.
RESULTS
There was no difference in preoperative clinical parameters between the two groups. Surgical time was significantly longer for LRYGB (159.2 vs. 115.3 min for LMGB, p < 0.001). The major complication rate was borderline higher for LRYGB (3.2 vs. 1.8%, p = 0.07). At 5 years after surgery, the mean BMI was lower in LMGB than LRYGB (27.7 vs. 29.2, p < 0.05) and LMGB also had a higher excess weight loss than LRYGB (72.9 vs. 60.1%, p < 0.05). Postoperative gastrointestinal quality of life increased significantly after operation in both groups without any significant difference at 5 years. Obesity-related clinical parameters improved in both groups without significant difference, but LMGB had a lower hemoglobin level than LRYGB. Late revision rate was similar between LRYGB and LMGB (3.6 vs. 2.8%, p = 0.385).
CONCLUSIONS
This study demonstrates that LMGBP can be regarded as a simpler and safer alternative to LRYGB with similar efficacy at a 10-year experience.
背景
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）被认为是治疗病态肥胖的金标准，但技术要求高，且术后并发症显著。虽然腹腔镜迷你胃旁路术（LMGB）已被报道为治疗病态肥胖的一种简单有效的方法，但仍存在争议。缺乏大量患者将 LMGB 与 LRYGB 进行比较的长期随访数据。
方法
2001 年 10 月至 2010 年 9 月，我们的综合肥胖手术中心共招募了 1657 例病态肥胖患者接受胃旁路手术（1163 例接受 LMGB，494 例接受 LRYGB）。排除接受修正手术的患者。最低随访时间为 1 年（平均 5.6 年，1-10 年）。评估手术时间、估计失血量、住院时间和手术并发症。在随访时确定晚期并发症、体重减轻、BMI、生活质量和合并症的变化。使用胃肠道生活质量指数评估生活质量的变化。
结果
两组患者术前临床参数无差异。LRYGB 的手术时间明显长于 LMGB（159.2 分钟比 115.3 分钟，p<0.001）。LRYGB 的主要并发症发生率略高（3.2%比 1.8%，p=0.07）。术后 5 年，LMGB 的平均 BMI 低于 LRYGB（27.7 比 29.2，p<0.05），LMGB 的多余体重减轻也高于 LRYGB（72.9%比 60.1%，p<0.05）。两组术后胃肠生活质量均显著改善，5 年后无显著差异。两组肥胖相关临床参数均有改善，但 LMGB 的血红蛋白水平低于 LRYGB。LRYGB 和 LMGB 的晚期修正率相似（3.6%比 2.8%，p=0.385）。
结论
这项研究表明，在 10 年的经验中，LMGBP 可以被视为 LRYGB 的一种更简单、更安全的替代方法，具有相似的疗效。
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