腹腔镜袖状胃切除术与腹腔镜胃旁路术的应用及结果：美国外科医师学会国家外科质量改进计划分析

Use and Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass: Analysis of the American College of Surgeons NSQIP.

作者信息

Young Monica T, Gebhart Alana, Phelan Michael J, Nguyen Ninh T

机构信息

Department of Surgery, University of California, Irvine, Irvine, CA.

Department of Statistics, University of California, Irvine, Irvine, CA.

出版信息

J Am Coll Surg. 2015 May;220(5):880-5. doi: 10.1016/j.jamcollsurg.2015.01.059. Epub 2015 Feb 16.

DOI:10.1016/j.jamcollsurg.2015.01.059

PMID:25907869

Abstract

BACKGROUND

Laparoscopic sleeve gastrectomy is gaining popularity in the United States. However, few studies have examined outcomes of sleeve gastrectomy compared with those of the "gold standard" bariatric operation: Roux-en-Y gastric bypass.

STUDY DESIGN

Using the American College of Surgeons National Surgical Quality Improvement Program database, clinical data were obtained for all patients who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass between 2010 and 2011. Main outcomes measures were risk-adjusted 30-day serious morbidity and mortality.

RESULTS

We analyzed 24,117 patients who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass for the treatment of morbid obesity. Gastric bypass comprised 79.5% of cases and sleeve gastrectomy comprised 20.5%; the proportion of sleeve gastrectomy cases increased from 14.6% in 2010 to 25.8% in 2011. On univariate analysis, sleeve gastrectomy had a shorter mean operative time (101 vs 133 minutes, p < 0.01), a lower rate of blood loss requiring transfusion (0.6% vs 1.5%, p < 0.01), a lower rate of deep wound infections (0.06% vs 0.20%, p = 0.05), lower serious morbidity rate (3.8% vs 5.8%, p < 0.01), and 30-day reoperation rate (1.6% vs 2.5%, p < 0.01), but a higher rate of deep venous thrombosis (0.47% vs 0.21%, p < 0.01). Compared with sleeve gastrectomy, gastric bypass patients had higher risk-adjusted 30-day serious morbidity (odds ratio [OR] 1.32; 95% CI1.11 to 1.56, p < 0.01). Patients who were older, had higher BMI, smoked, or had hypertension were at significantly greater risk of serious morbidity. The 30-day mortality was similar between groups (0.10% for sleeve vs 0.15% for bypass).

CONCLUSIONS

Use of laparoscopic sleeve gastrectomy is increasing on a national level. Compared with laparoscopic gastric bypass, laparoscopic sleeve gastrectomy is associated with lower 30-day risk-adjusted serious morbidity and equivalent 30-day mortality.

摘要

背景

腹腔镜袖状胃切除术在美国正越来越受欢迎。然而，与“金标准”减肥手术—— Roux-en-Y胃旁路术相比，很少有研究探讨袖状胃切除术的疗效。

研究设计

利用美国外科医师学会国家外科质量改进计划数据库，获取了2010年至2011年间接受腹腔镜袖状胃切除术或腹腔镜胃旁路术的所有患者的临床数据。主要结局指标为风险调整后的30天严重并发症和死亡率。

结果

我们分析了24117例接受腹腔镜袖状胃切除术或腹腔镜胃旁路术治疗病态肥胖的患者。胃旁路术占病例的79.5%，袖状胃切除术占20.5%；袖状胃切除术病例的比例从2010年的14.6%增至2011年的25.8%。单因素分析显示，袖状胃切除术的平均手术时间较短（101分钟对133分钟，p<0.01），需要输血的失血率较低（0.6%对1.5%，p<0.01），深部伤口感染率较低（0.06%对0.20%，p = 0.05），严重并发症发生率较低（3.8%对5.8%，p<0.01），以及30天再次手术率较低（1.6%对2.5%，p<0.01），但深静脉血栓形成率较高（0.47%对0.21%，p<0.01）。与袖状胃切除术相比，胃旁路术患者的风险调整后30天严重并发症发生率更高（优势比[OR] 1.32；95%CI 1.11至1.56，p<0.01）。年龄较大、BMI较高、吸烟或患有高血压的患者发生严重并发症的风险显著更高。两组间的30天死亡率相似（袖状胃切除术为0.10%，胃旁路术为0.15%）。