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腹腔镜胃旁路手术对老年肥胖患者(年龄>60 岁)共病和生活质量的影响:我们在英国的经验。

The Impact of Laparoscopic Gastric Bypass on Comorbidities and Quality of Life in the Older Obese Patients (Age > 60): Our UK Experience.

机构信息

Department of Upper Gastrointestinal Surgery, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK.

Department of Upper Gastrointestinal Surgery, University Hospital of North Midlands, Newcastle Road, Stoke-On-Trent, ST4 6QG, UK.

出版信息

Obes Surg. 2018 Dec;28(12):3890-3894. doi: 10.1007/s11695-018-3414-6.

DOI:10.1007/s11695-018-3414-6
PMID:30056573
Abstract

BACKGROUND

With population ageing, more older patients would benefit from the reduced comorbidities associated with laparoscopic Roux-en-Y gastric bypass (LRYGB). However, health care providers are still reluctant to offer bariatric surgery to older obese patients due to the perceived increased risk and possible reduced benefit. Here, we report the outcomes of first UK series of LRYGB in patients (> 60 years) with emphasis on quality of life (QoL).

SETTING

University hospital.

METHODS

Data was collected prospectively on all patients aged > 60 years undergoing LRYGB between 2006 and 2011. Patients had a minimum 1-year follow-up. Data related to weight loss, peri-operative complications and obesity-related morbidity (ORM) was collected. Patients' QoL was assessed by postal questionnaire.

RESULTS

Forty-six patients with a median age of 63 (60-71) underwent LRYGB with a median follow-up of 23 (12-55) months. There was a significant drop in patients' BMI [mean (SD) 47.5 (6.2) to 31.2 (4.4) kg/m]. Patients had an average 69% (SD 17%) excess weight loss and 34% (SD 10%) total body weight loss. The median hospital stay was 3 (1-16) with 13% peri-operative morbidity and no mortality. There was a 25% (30/123) resolution and 54% (66/123) 'improvement' in ORM. The QoL score increased significantly in several domains particularly physical performance (2.8 to 8.0, p < 0.001), self-esteem (3.6 to 8.3, p < 0.001) and mobility (2.9 to 7.5, p < 0.001).

CONCLUSION

LRYGB in patients aged > 60 years can be performed safely and with weight loss comparable to younger patients. There is associated benefit in reducing ORM and substantial improvement in QoL.

摘要

背景

随着人口老龄化,更多的老年患者将受益于腹腔镜 Roux-en-Y 胃旁路术(LRYGB)相关合并症的减少。然而,由于认为风险增加且可能获益减少,医疗保健提供者仍不愿为老年肥胖患者提供减重手术。在此,我们报告了英国首例 LRYGB 系列病例,重点介绍了生活质量(QoL)。

地点

大学医院。

方法

前瞻性收集了 2006 年至 2011 年间所有年龄>60 岁接受 LRYGB 的患者的数据。患者的随访时间至少为 1 年。收集了与减重、围手术期并发症和肥胖相关疾病(ORM)相关的数据。通过邮寄问卷评估患者的 QoL。

结果

46 名患者的中位年龄为 63(60-71)岁,中位随访时间为 23(12-55)个月。患者的 BMI 显著下降[平均(SD)47.5(6.2)至 31.2(4.4)kg/m]。患者的平均体重减轻了 69%(SD 17%),总体重减轻了 34%(SD 10%)。中位住院时间为 3(1-16)天,围手术期发病率为 13%,无死亡。25%(30/123)的 ORM 得到解决,54%(66/123)得到“改善”。几个领域的 QoL 评分显著提高,特别是身体机能(2.8 至 8.0,p<0.001)、自尊(3.6 至 8.3,p<0.001)和移动能力(2.9 至 7.5,p<0.001)。

结论

年龄>60 岁的患者行 LRYGB 是安全的,体重减轻与年轻患者相当。减少 ORM 和生活质量的显著提高是相关的获益。

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本文引用的文献

1
Bariatric surgery in elderly patients: a systematic review.老年患者的减重手术:一项系统综述
Clin Interv Aging. 2015 Oct 13;10:1627-35. doi: 10.2147/CIA.S70313. eCollection 2015.
2
Does bariatric surgery improve the patient's quality of life?减肥手术能改善患者的生活质量吗?
Nutr Hosp. 2010 Nov-Dec;25(6):925-30.