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腹腔镜袖状胃切除术与腹腔镜可调节胃束带术治疗病态肥胖的一年疗效

One-year outcomes of laparoscopic sleeve gastrectomy versus laparoscopic adjustable gastric banding for the treatment of morbid obesity.

作者信息

Young Monica T, Gebhart Alana, Khalaf Racha, Toomari Nojan, Vu Stephen, Smith Brian, Nguyen Ninh T

机构信息

Department of Surgery, University of California Irvine Medical Center, Orange, California, USA.

出版信息

Am Surg. 2014 Oct;80(10):1049-53.

Abstract

Sleeve gastrectomy is emerging to be the procedure of choice in the management of severe obesity. The aim of this study was to analyze outcomes between patients who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic adjustable gastric banding (LAGB). A retrospective matched cohort analysis was performed between 150 patients who underwent LSG versus 150 patients who underwent LAGB. The cohorts were matched for age, gender, body mass index (BMI), and preoperative comorbidities. Length of hospital stay (1.6 vs 1.1 days, P < 0.01) was longer in the LSG group. Perioperative complications were similar between groups (4.6% for LSG vs 2.0% for LAGB) but the late complication rate was significantly lower in the LSG group (1.3 vs 8.0%). The 30-day reoperation (0 vs 0.7%) and readmission (1.3 vs 1.3%) rates were similar between groups. There were no 90-day mortalities in the study. The mean reduction in BMI was significantly higher for LSG (-11.9 kg/m(2) for LSG vs -6.2 kg/m(2) for LAGB, P < 0.01) at 1-year follow-up. The number of medications used to control all comorbidities was significantly lower at follow-up compared with baseline for both groups. The mean reduction in the number medications used to control hypertension was greater in the LSG group (-1.00 ± 0.70 vs -0.35 ± 0.70 medications, P < 0.01). LSG has a perioperative safety profile comparable to that of LAGB but achieved significantly better weight loss and control of hypertension with a lower rate of late complications.

摘要

袖状胃切除术正逐渐成为治疗重度肥胖的首选术式。本研究的目的是分析接受腹腔镜袖状胃切除术(LSG)与腹腔镜可调节胃束带术(LAGB)的患者之间的手术效果。对150例行LSG的患者和150例行LAGB的患者进行了回顾性匹配队列分析。两组队列在年龄、性别、体重指数(BMI)和术前合并症方面进行了匹配。LSG组的住院时间更长(1.6天对1.1天,P<0.01)。两组围手术期并发症相似(LSG为4.6%,LAGB为2.0%),但LSG组的晚期并发症发生率显著更低(1.3%对8.0%)。两组的30天再次手术率(0对0.7%)和再入院率(1.3%对1.3%)相似。本研究中无90天死亡率。在1年随访时,LSG组的BMI平均降低幅度显著更高(LSG为-11.9kg/m²,LAGB为-6.2kg/m²,P<0.01)。与基线相比,两组随访时用于控制所有合并症的药物数量均显著减少。LSG组用于控制高血压的药物数量平均减少幅度更大(-1.00±0.70种对-0.35±0.70种药物,P<0.01)。LSG的围手术期安全性与LAGB相当,但在体重减轻和高血压控制方面取得了显著更好的效果,且晚期并发症发生率更低。

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