Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Obes Surg. 2013 Sep;23(9):1476-80. doi: 10.1007/s11695-013-0999-7.
Within the last decade, several authors have proposed laparoscopic sleeve gastrectomy (LSG) as a potential definitive treatment for morbid obesity. While initially perceived as being a solely restrictive procedure, it is now theorized to have additional hormonal effects (primarily the reduction of circulating levels of plasma ghrelin). However, there is limited supporting evidence for this claim. Therefore, the purpose of our study is to conduct a systematic review of the literature to clarify the effects of LSG on modulation of postoperative ghrelin concentrations. A comprehensive literature search for published or unpublished studies of sleeve gastrectomy (SG) and ghrelin written in English prior to February 2013 was performed using Pubmed, EMBASE, the Cochrane database, and Scopus. Gray literature was also searched through Google. Inclusion criteria for searches were: randomized controlled trials, non-randomized clinical trials, retrospective and prospective cohort studies, or case series. Seven studies were deemed suitable for analysis. The mean patient age was 43 ± 8.8 years and female percentage was 74.4 ± 15.3 %. The mean initial BMI was 46.2 ± 7.8 and mean follow-up time was 9.5 ± 15 months. The mean postoperative BMI was 37.3 ± 5.8 over the same follow-up period. Pooled mean preoperative ghrelin levels were 698.4 ± 312.4 pg/ml and postoperative levels were 414.1 ± 226.3 pg/ml (P < 0.0001). Pooled analysis of ghrelin levels at 3, 6, and 12 months showed a significant reduction in circulating levels. Our systematic review shows that LSG has a significant effect on ghrelin levels, leading to considerable reduction in circulation levels following surgery. Further research and standardization is necessary to clearly establish a causative relationship between LSG and reduction of circulating ghrelin levels.
在过去的十年中，有几位作者提出腹腔镜袖状胃切除术（LSG）作为病态肥胖的潜在根治性治疗方法。虽然最初被认为仅是一种限制手术，但现在理论上它具有额外的激素作用（主要是降低循环血浆胃饥饿素水平）。然而，这种说法的支持证据有限。因此，我们的研究目的是对文献进行系统综述，以阐明 LSG 对术后胃饥饿素浓度调节的影响。使用 Pubmed、EMBASE、Cochrane 数据库和 Scopus 对截至 2013 年 2 月发表或未发表的关于袖状胃切除术（SG）和胃饥饿素的英文研究进行了全面的文献检索。还通过 Google 搜索灰色文献。搜索的纳入标准是：随机对照试验、非随机临床试验、回顾性和前瞻性队列研究或病例系列。有 7 项研究适合进行分析。患者的平均年龄为 43 ± 8.8 岁，女性百分比为 74.4 ± 15.3%。初始平均 BMI 为 46.2 ± 7.8，平均随访时间为 9.5 ± 15 个月。同一随访期间术后 BMI 平均为 37.3 ± 5.8。术前平均胃饥饿素水平为 698.4 ± 312.4 pg/ml，术后水平为 414.1 ± 226.3 pg/ml（P < 0.0001）。胃饥饿素水平在 3、6 和 12 个月时的汇总分析显示，循环水平显著降低。我们的系统评价表明 LSG 对胃饥饿素水平有显著影响，导致手术后循环水平显著降低。需要进一步的研究和标准化，以明确 LSG 与循环胃饥饿素水平降低之间的因果关系。
