荷兰减重手术体重变化图表：多中心工具，用于评估袖状胃切除术和腹腔镜 Roux-en-Y 胃旁路术后长达 7 年的体重结局。

The Dutch bariatric weight loss chart: A multicenter tool to assess weight outcome up to 7 years after sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.

机构信息

MC Slotervaart Hospital, Amsterdam, the Netherlands.

Catharina Hospital, Eindhoven, the Netherlands.

出版信息

Surg Obes Relat Dis. 2019 Feb;15(2):200-210. doi: 10.1016/j.soard.2018.11.024. Epub 2018 Nov 24.

DOI:10.1016/j.soard.2018.11.024

PMID:30797718

Abstract

BACKGROUND

Current methods for weight loss assessment after bariatric surgery do not meet the high standards required to accurately judge patient outcome in a fair and evidence-based way.

OBJECTIVES

To build an evidence-based, versatile tool to assess weight loss and weight regain and identify poor responders up to 7 years after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), for any preoperative body mass index (BMI).

SETTING

Multicenter, observational study.

METHODS

Bariatric weight loss charts were built with standard deviation (SD) percentile (p) curves p+2SD/p+1SD/p50(median)/p-1SD/p-2SD, based on all last measured weight results after primary LRYGB and LSG, performed in 3 large bariatric centers, expressed with percentage total weight loss (%TWL) and percentage-alterable weight loss (%AWL), a special BMI-independent metric. The p-1SD %AWL curves were compared with popular bariatric criteria 50% excess weight loss and 20%TWL. The p50 %TWL curves were compared with %TWL outcome in literature (external validation).

RESULTS

In total, 9393 patients (5516 LRYGB, 3877 LSG, baseline BMI 43.7 (±SD 5.3) kg/m, age 43 (±SD 10.9) years, 20% male, 21% type 2 diabetes) had mean follow-up 26 (range, 0-109) months, with .09% 30-day mortality. Independent outcome is presented in percentile charts for %AWL and %TWL. Percentile curves p+2SD/p+1SD/p50/p-1SD/p-2SD showed for LRYGB 72%/62%/50%/38%/28%AWL at nadir, 66%/55%/43%/30%/17%AWL at 4 years, 64%/52%/38%/25%/11%AWL at 7 years, and for LSG 69%/58%/46%/34%/22%AWL, 65%/53%/38%/23%/12%AWL, and 63%/51%/35%/22%/9%AWL, respectively. Bariatric criteria 50% excess weight loss and 20%TWL matched with most insufficient results for LSG, but not for LRYGB (low specificities). Both p50 %TWL curves are comparable with long-term weight loss in bariatric literature.

CONCLUSIONS

Just as well-known growth charts are essential for pediatrics, weight loss charts should become the tools of choice for bariatrics. These multicenter charts are baseline BMI independent, superior to current bariatric criteria, and quite intuitive to use. They allow to readily detect poor responders in any postoperative phase, monitor the effect of extra counseling, judge weight regain, and manage patient expectations.

摘要

背景

目前用于评估减重手术后体重减轻的方法无法满足准确判断患者预后的高标准，无法公平且基于证据地进行判断。

目的

建立一种基于证据、功能多样的工具，以评估腹腔镜 Roux-en-Y 胃旁路术（LRYGB）和腹腔镜袖状胃切除术（LSG）后长达 7 年的体重减轻和体重反弹情况，并识别减重不良应答者，适用于任何术前体重指数（BMI）。

设置

多中心、观察性研究。

方法

基于 3 家大型减重中心初次 LRYGB 和 LSG 后所有最后一次测量的体重结果，构建了基于标准差（SD）百分位数（p）曲线的减重图表，包括 p+2SD/p+1SD/p50（中位数）/p-1SD/p-2SD，用百分比总减重（%TWL）和百分比可改变减重（%AWL）表示，这是一种特殊的 BMI 独立指标。p-1SD %AWL 曲线与流行的减重标准 50%多余体重减轻和 20%TWL 进行了比较。p50 %TWL 曲线与文献中的减重结果（外部验证）进行了比较。

结果

共纳入 9393 例患者（5516 例 LRYGB，3877 例 LSG，基线 BMI 43.7（±5.3）kg/m，年龄 43（±10.9）岁，20%为男性，21%患有 2 型糖尿病），平均随访 26（0-109）个月，30 天死亡率为 0.09%。呈现了独立的减重不良应答者的百分位图表，包括%AWL 和 %TWL。LRYGB 的 p+2SD/p+1SD/p50/p-1SD/p-2SD 分别为 72%/62%/50%/38%/28%AWL 达到最低点，4 年时为 66%/55%/43%/30%/17%AWL，7 年时为 64%/52%/38%/25%/11%AWL；LSG 的 p+2SD/p+1SD/p50/p-1SD/p-2SD 分别为 69%/58%/46%/34%/22%AWL，65%/53%/38%/23%/12%AWL，63%/51%/35%/22%/9%AWL。减重标准 50%多余体重减轻和 20%TWL 与 LSG 的大部分不足结果匹配，但与 LRYGB 不匹配（特异性低）。p50 %TWL 曲线与减重文献中的长期减重结果相当。