Department of Pulmonology, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands,
Obes Surg. 2013 Oct;23(10):1596-603. doi: 10.1007/s11695-013-0928-9.
Obesity is associated with respiratory symptoms and impaired pulmonary function, which could increase the risk of complications after bariatric surgery. The purpose of this study is to assess the relationship between pulmonary function parameters before, and the risk of complications after, laparoscopic bariatric surgery.
This prospective study included patients (age 18-60, BMI >35 kg/m2), who were eligible for bariatric surgery. Spirometry was performed in all patients. Complications up to 30 days after bariatric surgery were recorded.
Four hundred eighty-five patients were included (304 laparoscopic sleeve gastrectomy, 181 laparoscopic gastric bypass). There were 53 complications (8 pulmonary, 27 surgical, 14 infectious, 4 other) in 50 patients (10%). There were 35 re-admissions (7.2%), and 17 re-laparoscopies (3.5%). Subjects with and without complications did not differ significantly with respect to demographics, weight, BMI, abdominal circumference or fat percentage. Subjects with complications had a significantly lower mean FEV1 (mean 86.9% predicted) and FVC (95.6% predicted) compared to patients without complications (95.9% predicted, p = 0.005, and 100.1% predicted, p = 0.045, respectively). After adjustment for age, gender, BMI, and smoking, abnormal spirometry value remained the single predictive covariable of postoperative complications: FEV1/FVC <70% adjusted OR 3.1 (95% CI 1.4-6.8, p = 0.006) and ΔFEV1 ≥12 % adjusted OR 2.9 (95% CI 1.3-6.6, p = 0.010).
The risk of pulmonary complications after laparoscopic bariatric surgery is low. However, subjects with abnormal spirometry test results have a threefold risk of complications after laparoscopic bariatric surgery. Preoperative pulmonary function testing might be useful to predict the risk of complications of laparoscopic bariatric surgery.
肥胖与呼吸症状和肺功能受损有关，这可能会增加减重手术后发生并发症的风险。本研究的目的是评估腹腔镜减重手术前后肺功能参数与并发症风险之间的关系。
本前瞻性研究纳入了符合减重手术条件的患者（年龄 18-60 岁，BMI＞35kg/m2）。所有患者均行肺功能检查。记录减重手术后 30 天内的并发症。
共纳入 485 例患者（304 例行腹腔镜袖状胃切除术，181 例行腹腔镜胃旁路术）。50 例患者（10%）发生 53 例并发症（8 例肺部，27 例手术，14 例感染，4 例其他）。35 例患者（7.2%）再入院，17 例（3.5%）再次腹腔镜检查。有或无并发症的患者在人口统计学特征、体重、BMI、腹围或体脂百分比方面无显著差异。有并发症的患者的平均 FEV1（预测值 86.9%）和 FVC（预测值 95.6%）明显低于无并发症的患者（预测值 95.9%，p=0.005 和 100.1%，p=0.045）。在校正年龄、性别、BMI 和吸烟后，异常的肺功能检查值仍然是术后并发症的唯一预测性协变量：FEV1/FVC＜70%的调整比值比为 3.1（95%可信区间为 1.4-6.8，p=0.006），FEV1 增加≥12%的调整比值比为 2.9（95%可信区间为 1.3-6.6，p=0.010）。
腹腔镜减重手术后发生肺部并发症的风险较低。然而，肺功能检查异常的患者腹腔镜减重手术后发生并发症的风险增加 3 倍。术前肺功能检查可能有助于预测腹腔镜减重手术的并发症风险。
