磁共振成像（MRI）显示腹腔镜袖状胃切除术对胃结构和功能的影响与术后体重减轻和生活质量密切相关：一项前瞻性研究。

Effects of Laparoscopic Sleeve Gastrectomy on Gastric Structure and Function Documented by Magnetic Resonance Imaging Are Strongly Associated with Post-operative Weight Loss and Quality of Life: a Prospective Study.

机构信息

IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.

Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00166, Rome, Italy.

出版信息

Obes Surg. 2020 Dec;30(12):4741-4750. doi: 10.1007/s11695-020-04831-7. Epub 2020 Jul 8.

DOI:10.1007/s11695-020-04831-7

PMID:32642883

Abstract

BACKGROUND

This prospective study applied magnetic resonance imaging (MRI) to assess the effect of laparoscopic sleeve gastrectomy (LSG) on gastric structure and function. The impact of these changes on patient outcomes was analyzed.

METHOD

Obese patients without gastrointestinal symptoms referred for bariatric surgery were recruited prospectively. Pre-operative assessment included (i) high-resolution manometry and pH-impedance monitoring and (ii) magnetic resonance imaging (MRI) measurement of gastric capacity, accommodation, and emptying with the 400 ml liquid Nottingham test meal (NTM). Studies were repeated 6-7 months after LSG. Weight loss and changes in the Gastrointestinal Quality of Life Index (GIQLI) assessed patient outcomes.

RESULTS

From 35 patients screened, 23 (66%) completed the study (17 females, age 36 ± 10 years, BMI 42 ± 5 kg/m2). Mean excess weight loss was 59 ± 18% at follow-up. Total gastric volume (capacity) after the meal was 467 mL (455-585 ml) before and 139 mL (121-185 ml) after LSG (normal reference 534 (419-675) mL), representing a mean 70% reduction (p < 0.0001). Similar findings were present for gastric content volume indicating rapid early-phase gastric emptying (GE) post-LSG. Conversely, late-phase GE was slower post-LSG (2.5 ± 1.0 vs. 1.4 ± 0.6 mL/min; p < 0.0001; (reference 1.5(1.4-4.9) mL/min)). Patients with ≥ 80% reduction in gastric capacity had greater weight loss (p = 0.008), but worse gastrointestinal outcomes (p = 0.023).

CONCLUSIONS

MRI studies quantified the marked reduction in gastric capacity after LSG. The reduction in capacity was associated with rapid early- but slow late-phase GE after surgery. These changes were associated with weight loss; however, reductions in gastric capacity ≥ 80% were linked to increased acid reflux and impacted on gastrointestinal quality of life.

摘要

背景

本前瞻性研究应用磁共振成像（MRI）评估腹腔镜袖状胃切除术（LSG）对胃结构和功能的影响。分析这些变化对患者结局的影响。

方法

前瞻性招募无胃肠道症状的肥胖患者进行减重手术。术前评估包括（i）高分辨率测压和 pH 阻抗监测，（ii）磁共振成像（MRI）测量胃容量、顺应性和排空，使用 400ml 诺丁汉测试餐（NTM）。LSG 后 6-7 个月重复这些研究。体重减轻和胃肠道生活质量指数（GIQLI）的变化评估患者结局。

结果

从 35 名筛查患者中，23 名（66%）完成了研究（17 名女性，年龄 36±10 岁，BMI 42±5kg/m2）。随访时平均超重减轻 59±18%。餐后总胃容量（容量）术前为 467ml（455-585ml），术后为 139ml（121-185ml）（正常参考值 534（419-675）ml），平均减少 70%（p<0.0001）。胃内容物容积也有类似发现，提示 LSG 后胃排空呈快速早期相。相反，LSG 后晚期胃排空较慢（2.5±1.0 比 1.4±0.6mL/min；p<0.0001；（参考值 1.5（1.4-4.9）mL/min））。胃容量减少≥80%的患者减重更多（p=0.008），但胃肠道结局更差（p=0.023）。