老年患者的减重手术：五年平均随访结果
BARIATRIC SURGERY IN THE ELDERLY: RESULTS OF A MEAN FOLLOW-UP OF FIVE YEARS.
作者信息
Pajecki Denis, Santo Marco Aurelio, Joaquim Henrique Dametto Giroud, Morita Flavio, Riccioppo Daniel, de Cleva Roberto, Cecconello Ivan
机构信息
Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
出版信息
Arq Bras Cir Dig. 2015;28 Suppl 1(Suppl 1):15-8. doi: 10.1590/S0102-6720201500S100006.
BACKGROUND
Surgical treatment of obesity in the elderly, particularly over 65, remains controversial; it is explained by the increased surgical risk or the lack of data demonstrating its long-term benefit. Few studies have evaluated the clinical effects of bariatric surgery in this population.
AIM
To evaluate the results of surgical treatment of obesity in patients over 60 years, followed for an average period of five years.
METHOD
This was a retrospective study evaluating 46 patients, 60 years or older, who underwent surgical treatment of obesity, by conventional gastric bypass technique (laparotomy). The average age was 64 years (60-71), mean BMI of 49.6 kg/m2 (38-66), mean follow-up of 5.9 years; 91% of patients were hypertensive, 56% diabetics and 39% had dyslipidemia.
RESULTS
The incidence of complications (major and minor) in patients under 65 years was 26% and over 65 years 37% (p=0.002). There were no deaths in the group with less than 65 years and there were two deaths (12.5%) over 65 years. The average loss of overweight over 65 years or less was 72% vs 68% (p=0.56). There was total control of the diabetes mellitus in 77% and partial in 23%, with no difference between groups. There was improvement in arterial hypertension in 56% of patients, also no difference between groups. The average LDL levels did not differ between the pre and postoperative (106 mg/dl to 102 mg/dl), an increase of HDL (56 mg/dl to 68 mg/dL) and reduced triglyceride levels (136 mg/dl to 109 mg/dl). There was no statistical difference in the variation of the cholesterol fractions and triglycerides between the groups. Two patients in the group with less than 65 years died in late follow-up, of brain tumor and pneumonia, three and five years after bariatric surgery, respectively.
CONCLUSIONS
Surgical morbidity and mortality were higher in patients over 65 years, and this group had the same benefits observed in patients lower 65 years for weight loss and comorbidities control.
背景
老年肥胖患者，尤其是65岁以上患者的手术治疗仍存在争议；这是由于手术风险增加或缺乏数据证明其长期益处所致。很少有研究评估减重手术在该人群中的临床效果。
目的
评估60岁以上肥胖患者接受手术治疗的结果，平均随访五年。
方法
这是一项回顾性研究，评估了46例60岁及以上接受传统胃旁路手术（剖腹术）治疗肥胖的患者。平均年龄为64岁（60 - 71岁），平均体重指数为49.6kg/m²（38 - 66），平均随访5.9年；91%的患者患有高血压，56%患有糖尿病，39%患有血脂异常。
结果
65岁以下患者的并发症（主要和次要）发生率为26%，65岁以上为37%（p = 0.002）。65岁以下组无死亡病例，65岁以上组有两例死亡（12.5%）。65岁及以下患者的超重平均减轻率为72%，65岁以上为68%（p = 0.56）。糖尿病总体控制率为77%，部分控制率为23%，两组之间无差异。56%的患者动脉高血压有所改善，两组之间也无差异。术前和术后低密度脂蛋白水平无差异（106mg/dl至102mg/dl），高密度脂蛋白增加（56mg/dl至68mg/dL），甘油三酯水平降低（136mg/dl至109mg/dl）。两组之间胆固醇组分和甘油三酯的变化无统计学差异。65岁以下组有两名患者在随访后期死亡，分别在减重手术后三年和五年死于脑肿瘤和肺炎。
结论
65岁以上患者的手术发病率和死亡率较高，但该组在减重和控制合并症方面与65岁以下患者具有相同的益处。
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