腹腔镜 Roux-en-Y 胃旁路术治疗病态肥胖的长期结果：105 例患者的随访时间至少为 15 年。
Long-term results of laparoscopic Roux-en-Y gastric bypass for morbid obesity: 105 patients with minimum follow-up of 15 years.
机构信息
Department of Public Health, "Federico II" University, Naples, Italy.
Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
出版信息
Surg Obes Relat Dis. 2021 Apr;17(4):727-736. doi: 10.1016/j.soard.2020.11.028. Epub 2020 Dec 1.
BACKGROUND
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the second most frequently performed bariatric procedure worldwide; however, long-term results are not frequently reported.
OBJECTIVES
To evaluate the outcomes of LRYGB on weight loss and co-morbidities in a single center 15 years after the operation.
SETTING
Tertiary-care referral hospital.
METHODS
From February 2000 to December 2003, 105 patients (86 women; mean age 39.9 ± 17.4; mean body mass index [BMI] 47.2 ± 6.4 kg/m; 78 with BMI < 50 kg/m and 27 with BMI ≥ 50 kg/m) underwent LRYGB. Retrospective analyses of a prospectively maintained database were carried out to evaluate weight loss; resolution of co-morbidities, including type 2 diabetes mellitus (T2D), hypertension (HTN), and dyslipidemia; complications; and nutritional status.
RESULTS
The follow-up rate at 15 years was 87.6%. Mean excess weight loss was 58.6 ± 27%, with 74.1% of patients achieving a total weight loss ≥ 20%. According to the Biron et al. criteria, an inadequate outcome was found in 11/21 (52.4%) of patients with an initial BMI ≥ 50 kg/m versus 21/64 (32.8%) of patients with a preoperative BMI < 50 kg/m (P = .001). Both groups experienced gradual weight regain (WR); specifically, 34.1% of patients regained more than 15% of their lowest postoperative weight. The rates of reoperations due to early and late surgical complications were 3.8% and 9.5%, respectively. T2D was resolved in 50% of patients, HTN in 61.1%, and dyslipidemia in 58.3%. Iron deficiency anemia (53%) was the most common postoperative nutritional finding.
CONCLUSION
LRYGB provides satisfactory weight loss and resolution of co-morbidities up to 15 years. WR was a common finding. A significant proportion of patients with a preoperative BMI ≥ 50 kg/m did not achieve a favorable weight loss outcome. Indications to perform LRYGB in this group of patients should be definitively reconsidered.
背景
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）是全球第二大常用减重手术，但长期结果报告并不常见。
目的
在术后 15 年，评估 LRYGB 对单中心体重减轻和合并症的影响。
设置
三级转诊医院。
方法
2000 年 2 月至 2003 年 12 月，105 例患者（86 例女性；平均年龄 39.9 ± 17.4 岁；平均体重指数[BMI] 47.2 ± 6.4 kg/m2；78 例 BMI < 50 kg/m2，27 例 BMI ≥ 50 kg/m2）接受了 LRYGB。对前瞻性维护的数据库进行回顾性分析，以评估体重减轻、合并症（包括 2 型糖尿病[T2D]、高血压[HTN]和血脂异常）的缓解情况、并发症和营养状况。
结果
15 年的随访率为 87.6%。平均超重减轻 58.6 ± 27%，74.1%的患者总减重≥20%。根据 Biron 等人的标准，初始 BMI≥50 kg/m2的 21 例患者中，有 11 例（52.4%）的结果不理想，而术前 BMI<50 kg/m2的 64 例患者中，有 21 例（32.8%）结果不理想（P =.001）。两组均逐渐出现体重反弹（WR）；具体而言，34.1%的患者体重反弹超过最低术后体重的 15%。因早期和晚期手术并发症导致的再手术率分别为 3.8%和 9.5%。50%的患者 T2D 得到缓解，61.1%的患者 HTN 得到缓解，58.3%的患者血脂异常得到缓解。缺铁性贫血（53%）是最常见的术后营养发现。
结论
LRYGB 可在术后 15 年内提供令人满意的体重减轻和合并症缓解。WR 是一种常见现象。术前 BMI≥50 kg/m2的患者中，相当一部分患者未达到理想的减重效果。应重新考虑对这组患者进行 LRYGB 的适应证。
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