Department of Surgery, University of California Irvine Medical Center, Orange, CA.
Department of Statistics, University of California Irvine, Irvine, CA.
Ann Surg. 2018 Jul;268(1):106-113. doi: 10.1097/SLA.0000000000002348.
The primary endpoints of this study were long-term weight loss, morbidity, and changes in comorbidities and quality of life.
Bariatric surgery is an effective option for the treatment of severe obesity and its related comorbidities. However, few studies have reported on the long-term outcome (>5 yrs) of bariatric surgery.
Between 2002 and 2007, 250 patients with a body mass index (BMI) of 35 to 60 kg/m were randomly assigned to undergo laparoscopic gastric bypass or laparoscopic gastric banding. After exclusions, 111 patients underwent gastric bypass and 86 patients underwent gastric banding. Factors predictive of improved weight loss were analyzed using multiple logistic regressions.
At baseline, the mean age was 43 ± 10 years and the mean BMI was 46.5 ± 5.6 kg/m. At 10-year follow-up, the mean total body weight loss for the entire cohort was -37.5 ± 19.4 kg, -42.4 ± 19.6 kg for gastric bypass versus -27.4 ± 14.5 kg for gastric banding. Late reoperation was significantly higher after gastric banding compared with the gastric bypass group (31.4% vs. 8.1%, respectively, P < 0.01). For the entire cohort, improvement or remission of diabetes occurred in 68%; 61% for hypertension; and 57% for dyslipidemia. The long-term mortality for the entire cohort was 1.0% at a mean follow-up of 9.5 ± 0.4 years. Factors predictive of improved weight loss included the type of operation (ie, gastric bypass), female sex, and the absence of diabetes at baseline. At long-term follow-up, quality of life continues to be improved from baseline for both the groups.
Bariatric surgery is an effective treatment for severe obesity with durable 10-year weight loss and improvement in comorbidities and quality of life. Compared with gastric banding, gastric bypass was associated with better long-term weight loss, lower rate of late reoperation, and improved remission of comorbidities.
本研究的主要终点是长期体重减轻、发病率以及合并症和生活质量的变化。
减重手术是治疗严重肥胖及其相关合并症的有效选择。然而，很少有研究报告减重手术的长期结果（>5 年）。
在 2002 年至 2007 年间，250 名 BMI 为 35 至 60kg/m 的患者被随机分配接受腹腔镜胃旁路手术或腹腔镜胃带手术。排除后，111 名患者接受胃旁路手术，86 名患者接受胃带手术。使用多因素逻辑回归分析预测体重减轻改善的因素。
基线时，平均年龄为 43±10 岁，平均 BMI 为 46.5±5.6kg/m。在 10 年随访时，整个队列的平均总体重减轻量为-37.5±19.4kg，胃旁路手术组为-42.4±19.6kg，胃带手术组为-27.4±14.5kg。与胃旁路手术组相比，胃带手术后晚期再次手术的比例明显更高（分别为 31.4%和 8.1%，P<0.01）。对于整个队列，糖尿病改善或缓解的发生率为 68%；高血压为 61%；血脂异常为 57%。整个队列的长期死亡率为 1.0%，平均随访时间为 9.5±0.4 年。预测体重减轻改善的因素包括手术类型（即胃旁路手术）、女性和基线时无糖尿病。在长期随访中，两组的生活质量都从基线开始持续改善。
减重手术是一种治疗严重肥胖症的有效方法，可实现 10 年持久的体重减轻，并改善合并症和生活质量。与胃带术相比，胃旁路术与更好的长期体重减轻、较低的晚期再次手术率以及改善合并症缓解率相关。
