Roux-en-Y胃旁路术与袖状胃切除术治疗超级肥胖患者的比较疗效
Comparative effectiveness of Roux-en-Y gastric bypass and sleeve gastrectomy in super obese patients.
作者信息
Celio Adam C, Wu Qiang, Kasten Kevin R, Manwaring Mark L, Pories Walter J, Spaniolas Konstantinos
机构信息
Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA.
Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA.
出版信息
Surg Endosc. 2017 Jan;31(1):317-323. doi: 10.1007/s00464-016-4974-y. Epub 2016 Jun 10.
BACKGROUND
The disproportionate increase in the super obese (SO) is a hidden component of the current obesity pandemic. Data on the safety and efficacy of bariatric procedures in this specific patient population are limited. Our aim is to assess the comparative effectiveness of the two most common bariatric procedures in the SO.
METHODS
Using the Bariatric Outcomes Longitudinal Database from 2007 to 2012, we compared SO patients (BMI ≥ 50) undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Stepwise logistic regression modeling was used to calculate a propensity score to adjust for patient demographics and comorbidities.
RESULTS
We identified 50,987 SO patients who underwent RYGB (N = 42,119) or SG (N = 8868). There was no difference in adjusted overall 30-day complication rate comparing RYGB and SG patients (11.5 vs. 11.1 %, p = 0.250). RYGB patients had higher adjusted rates of 30-day mortality (0.3 vs. 0.2 %, p = 0.042), reoperation (4.0 vs. 2.4 %, p < 0.001), and readmission (6.9 vs. 5.5 %, p < 0.001) compared to SG patients. The percent of total weight loss (%TWL) was significantly higher for RYGB patients compared to SG at 3 months (14.1 vs. 13.1 %, p < 0.001), 6 months (25.2 vs. 22.4 %, p < 0.001), and 12 months (34.5 vs. 29.7 %, p < 0.001). RYGB patients had increased resolution of all measured comorbidities: diabetes mellitus (61.6 vs. 50.8 %, p < 0.001), hypertension (43.1 vs. 34.5 %, p < 0.001), gastroesophageal reflux disease (53.9 vs. 32.5 %, p < 0.001), hyperlipidemia (39.7 vs. 32.5 %, p < 0.001), and obstructive sleep apnea (42.8 vs. 40.6 %, p = 0.058) at 12 months compared to SG patients.
CONCLUSIONS
There are significant differences in comorbidity improvement and resolution as well as weight loss between RYGB and SG in the SO population. There was no difference in overall 30-day complications, but more RYGB patients required readmission and reoperation. However, RYGB was considerably more effective in controlling obesity-related comorbidities. Our results favor performance of RYGB in SO patients of appropriate risk.
背景
超级肥胖（SO）人群的不成比例增加是当前肥胖流行的一个隐藏因素。关于减肥手术在这一特定患者群体中的安全性和有效性的数据有限。我们的目的是评估两种最常见的减肥手术在超级肥胖患者中的相对有效性。
方法
利用2007年至2012年的减肥手术纵向数据库，我们比较了接受腹腔镜Roux-en-Y胃旁路术（RYGB）或袖状胃切除术（SG）的超级肥胖患者（BMI≥50）。采用逐步逻辑回归模型计算倾向得分，以调整患者的人口统计学特征和合并症。
结果
我们确定了50987例接受RYGB（N = 42119）或SG（N = 8868）的超级肥胖患者。比较RYGB和SG患者，调整后的30天总体并发症发生率无差异（11.5%对11.1%，p = 0.250）。与SG患者相比，RYGB患者的30天死亡率（0.3%对0.2%，p = 0.042）、再次手术率（4.0%对2.4%，p < 0.001）和再入院率（6.9%对5.5%，p < 0.001）更高。在3个月（14.1%对13.1%，p < 0.001）、6个月（25.2%对22.4%，p < 0.001）和12个月（34.5%对29.7%，p < 0.001）时，RYGB患者的总体体重减轻百分比（%TWL）显著高于SG患者。与SG患者相比，RYGB患者在12个月时所有测量的合并症的缓解情况均有所改善：糖尿病（61.6%对50.8%，p < 0.001）、高血压（43.1%对34.5%，p < 0.001）、胃食管反流病（53.9%对32.5%，p < 0.001）、高脂血症（39.7%对32.5%，p < 0.001）和阻塞性睡眠呼吸暂停（42.8%对40.6%，p = 0.058）。
结论
在超级肥胖人群中，RYGB和SG在合并症改善和缓解以及体重减轻方面存在显著差异。30天总体并发症无差异，但更多的RYGB患者需要再次入院和再次手术。然而，RYGB在控制肥胖相关合并症方面明显更有效。我们的结果支持在具有适当风险的超级肥胖患者中进行RYGB手术。
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