Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, P.R. China.
Surg Obes Relat Dis. 2018 Sep;14(9):1348-1356. doi: 10.1016/j.soard.2018.05.016. Epub 2018 May 29.
The effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on metabolic syndrome (MS) in morbidly obese patients have not been well studied.
To compare the effectiveness of LSG and LRYGB in Chinese morbidly obese patients with MS.
University Hospital, China.
Patients who underwent LRYGB or LSG surgery and had completed at least 1 year of follow-up were retrospectively reviewed. Bariatric and metabolic outcomes in the 2 groups were compared. Univariate and multivariate analyses were performed to identify the predictors of MS remission.
Of the 176 patients enrolled in this study, 79 underwent LSG and 97 underwent LRYGB. Eighty-three met 3 of the International Diabetes Federation criteria for diagnosis of MS, 69 met 4 of the criteria, and 24 met 5 of the criteria. At 1 year after bariatric surgery, 79% of patients achieved remission of MS. In both LSG and LRYGB groups, the number of MS criteria met by patients decreased significantly after surgery. The MS remission rate was not significantly different between the 2 groups (74.7% in LSG versus 82.5% in LGB; P = .21). In LSG patients, there was no significant decrease in blood pressure or increase in the high-density lipoprotein cholesterol at 1 year. On logistic regression analysis, younger age, lower body mass index, and lower homeostatic model of assessment-insulin resistance were independently associated with MS remission at 1 year after surgery. Both groups showed satisfactory and comparable weight loss (percentage of excess weight loss: 71.7% in LSG versus 74.4% in LRYGB). No surgery-related mortality occurred.
Both LSG and LRYGB are feasible, safe, and effective in Chinese obese patients with MS. LSG seems to be inferior to LRYGB with regard to control of hypertension and high-density lipoprotein cholesterol.
腹腔镜袖状胃切除术（LSG）和腹腔镜 Roux-en-Y 胃旁路术（LRYGB）对病态肥胖患者代谢综合征（MS）的影响尚未得到很好的研究。
比较 LSG 和 LRYGB 治疗中国病态肥胖合并 MS 患者的疗效。
中国大学医院。
回顾性分析行 LRYGB 或 LSG 手术且至少完成 1 年随访的患者。比较两组患者的减重和代谢结局。采用单因素和多因素分析确定 MS 缓解的预测因素。
本研究共纳入 176 例患者，79 例行 LSG，97 例行 LRYGB。83 例患者符合国际糖尿病联合会（IDF）诊断 MS 的 3 项标准，69 例符合 4 项标准，24 例符合 5 项标准。减重手术后 1 年，79%的患者 MS 得到缓解。LSG 和 LRYGB 组患者术后 MS 符合标准的数量均显著减少。两组患者 MS 缓解率无显著差异（LSG 组为 74.7%，LRYGB 组为 82.5%；P=0.21）。LSG 组患者术后 1 年血压无显著下降，高密度脂蛋白胆固醇（HDL-C）升高不明显。多因素 logistic 回归分析显示，年龄较小、体重指数较低和胰岛素抵抗评估的稳态模型（HOMA-IR）较低与术后 1 年 MS 缓解独立相关。两组患者减重效果均令人满意且相当（LSG 组：体重超标减轻百分比为 71.7%，LRYGB 组为 74.4%）。无手术相关死亡。
LSG 和 LRYGB 治疗中国肥胖合并 MS 患者均安全有效。在控制高血压和 HDL-C 方面，LSG 似乎不如 LRYGB。
