Shah Kamran, Johnny Nergard Bent, Stray Frazier Katinka, Geir Leifsson Björn, Aghajani Ebrahim, Gislason Hjörtur
Aleris Obesity Clinic and Department of Surgery, Aleris Hospital, Oslo, Norway.
Aleris Obesity Clinic and Department of Surgery, Aleris Hospital, Oslo, Norway.
Surg Obes Relat Dis. 2016 Sep-Oct;12(8):1449-1456. doi: 10.1016/j.soard.2016.03.017. Epub 2016 Mar 19.
Diseases associated with obesity such as type 2 diabetes (T2D), hypertension, and dyslipidemia are common and together are defined as metabolic syndrome (MetS). The aim of this study was to evaluate long-term effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) in morbidly obese patients with MetS.
This was a retrospective study of data from a prospective database in a single center from 2005 to 2013 including 3795 LRYGB operated obese patients. Metabolic syndrome was defined according to the International Diabetes Federation Consensus Definition of Metabolic Syndrome from 2006.
In the study population, 79% of the patients were women, the preoperative median age was 42.4 years, and median body mass index (BMI, kg/m) was 40.9. MetS was diagnosed in 60% of the patients (2275/3795), with increased frequency in men and in those with higher age, higher BMI, and greater waist circumference; 27.5% of patients had impaired glucose metabolism, 40% hypertension, and 30% dyslipidemia. Postoperative follow-up rate>5 years was 71% (595/839). We found that 86.2% had resolution of MetS. After 5-9 years, complete remission of T2D was achieved in 78%, hypertension in 51%, and dyslipidemia in 89%. Mean excess BMI loss was significantly lower for patients with MetS (73.1%) compared with patients without MetS (75.6%) (P<.01). Early complications (leakage or hemorrhage) occurred in 1.2% (48/3975) and internal hernia in 7.8% (310/3975). Presence of MetS did not increase complication rates.
LRYGB in obese patients is associated with a significant and sustained reduction in excessive weight. In the present study, 86.2% of patients with MetS achieved complete remission and complication rates were low. Early bariatric surgery should be considered in patients with obesity and concurrent MetS.
与肥胖相关的疾病，如2型糖尿病（T2D）、高血压和血脂异常很常见，这些疾病共同被定义为代谢综合征（MetS）。本研究的目的是评估腹腔镜Roux-en-Y胃旁路术（LRYGB）对患有MetS的病态肥胖患者的长期影响。
这是一项对2005年至2013年来自单一中心前瞻性数据库的数据进行的回顾性研究，该数据库包含3795例接受LRYGB手术的肥胖患者。代谢综合征根据2006年国际糖尿病联盟代谢综合征共识定义来确定。
在研究人群中，79%的患者为女性，术前中位年龄为42.4岁，中位体重指数（BMI，kg/m²）为40.9。60%的患者（2275/3795）被诊断为MetS，男性以及年龄较大、BMI较高和腰围较大的患者中MetS的发生率更高；27.5%的患者有糖代谢受损，40%有高血压，30%有血脂异常。术后随访时间>5年的比例为71%（595/839）。我们发现86.2%的患者MetS得到缓解。5至9年后，78%的T2D患者、51%的高血压患者和89%的血脂异常患者实现了完全缓解。与无MetS的患者（75.6%）相比，有MetS的患者平均超重BMI降低幅度显著更低（73.1%）（P<0.01）。早期并发症（渗漏或出血）发生率为1.2%（48/3975），内疝发生率为7.8%（310/3975）。MetS的存在并未增加并发症发生率。
肥胖患者接受LRYGB手术可显著且持续减轻超重。在本研究中，86.2%的MetS患者实现了完全缓解，且并发症发生率较低。对于肥胖合并MetS的患者，应考虑早期进行减肥手术。
