减肥手术治疗颅咽管瘤相关性下丘脑性肥胖的疗效与安全性：一项为期2年随访的配对病例对照研究
Efficacy and safety of bariatric surgery for craniopharyngioma-related hypothalamic obesity: a matched case-control study with 2 years of follow-up.
作者信息
Wijnen M, Olsson D S, van den Heuvel-Eibrink M M, Wallenius V, Janssen J A M J L, Delhanty P J D, van der Lely A J, Johannsson G, Neggers S J C M M
机构信息
Department of Paediatric Oncology and Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Section Endocrinology, Department of Medicine, Pituitary Centre Rotterdam, Erasmus University Medical Centre, Rotterdam, The Netherlands.
出版信息
Int J Obes (Lond). 2017 Feb;41(2):210-216. doi: 10.1038/ijo.2016.195. Epub 2016 Oct 31.
BACKGROUND
Hypothalamic obesity is a devastating consequence of craniopharyngioma. Bariatric surgery could be a promising therapeutic option. However, its efficacy and safety in patients with craniopharyngioma-related hypothalamic obesity remain largely unknown.
OBJECTIVES
We investigated the efficacy of bariatric surgery for inducing weight loss in patients with craniopharyngioma-related hypothalamic obesity. In addition, we studied the safety of bariatric surgery regarding its effects on hormone replacement therapy for pituitary insufficiency.
METHODS
In this retrospective matched case-control study, we compared weight loss after bariatric surgery (that is, Roux-en-Y gastric bypass and sleeve gastrectomy) between eight patients with craniopharyngioma-related hypothalamic obesity and 75 controls with 'common' obesity during 2 years of follow-up. We validated our results at 1 year of follow-up in a meta-analysis. In addition, we studied alterations in hormone replacement therapy after bariatric surgery in patients with craniopharyngioma.
RESULTS
Mean weight loss after bariatric surgery was 19% vs 25% (difference -6%, 95% confidence of interval (CI) -14.1 to 4.6; P=0.091) at 2 years of follow-up in patients with craniopharyngioma-related hypothalamic obesity compared with control subjects with 'common' obesity. Mean weight loss was 25% vs 29% (difference -4%, 95% CI -11.6 to 8.1; P=0.419) after Roux-en-Y gastric bypass and 10% vs 20% (difference -10%, 95% CI -14.1 to -6.2; P=0.003) after sleeve gastrectomy at 2 years of follow-up in patients with craniopharyngioma-related hypothalamic obesity vs control subjects with 'common' obesity. Our meta-analysis demonstrated significant weight loss 1 year after Roux-en-Y gastric bypass, but not after sleeve gastrectomy. Seven patients with craniopharyngioma suffered from pituitary insufficiency; three of them required minor adjustments in hormone replacement therapy after bariatric surgery.
CONCLUSIONS
Weight loss after Roux-en-Y gastric bypass, but not sleeve gastrectomy, was comparable between patients with craniopharyngioma-related hypothalamic obesity and control subjects with 'common' obesity at 2 years of follow-up. Bariatric surgery seems safe regarding its effects on hormone replacement therapy.
背景
下丘脑性肥胖是颅咽管瘤的严重后果。减肥手术可能是一种有前景的治疗选择。然而，其在颅咽管瘤相关性下丘脑性肥胖患者中的疗效和安全性仍 largely 未知。
目的
我们研究了减肥手术对颅咽管瘤相关性下丘脑性肥胖患者诱导体重减轻的疗效。此外，我们研究了减肥手术对垂体功能不全激素替代治疗影响的安全性。
方法
在这项回顾性匹配病例对照研究中，我们比较了 8 例颅咽管瘤相关性下丘脑性肥胖患者与 75 例“普通”肥胖对照在减肥手术后（即 Roux-en-Y 胃旁路术和袖状胃切除术）2 年随访期间的体重减轻情况。我们在一项荟萃分析中对 1 年随访结果进行了验证。此外，我们研究了颅咽管瘤患者减肥手术后激素替代治疗的变化。
结果
与“普通”肥胖对照相比，颅咽管瘤相关性下丘脑性肥胖患者在 2 年随访时，减肥手术后平均体重减轻分别为 19% 对 25%（差异 -6%，95% 置信区间（CI）-14.1 至 4.6；P = 0.091）。在颅咽管瘤相关性下丘脑性肥胖患者与“普通”肥胖对照中，Roux-en-Y 胃旁路术后 2 年随访时平均体重减轻分别为 25% 对 29%（差异 -4%，95% CI -11.6 至 8.1；P = 0.419），袖状胃切除术后分别为 10% 对 20%（差异 -10%，95% CI -14.1 至 -6.2；P = 0.003）。我们的荟萃分析表明 Roux-en-Y 胃旁路术后 1 年体重显著减轻，但袖状胃切除术后未出现。7 例颅咽管瘤患者存在垂体功能不全；其中 3 例在减肥手术后需要对激素替代治疗进行轻微调整。
结论
在 2 年随访时，颅咽管瘤相关性下丘脑性肥胖患者与“普通”肥胖对照相比，Roux-en-Y 胃旁路术后体重减轻情况可比，袖状胃切除术后则不然。减肥手术对激素替代治疗的影响似乎是安全的。
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