胆胰转流术（BPD）、长共同肠段胆胰转流术（BPD + LCL-R）、胃旁路术[RYGB]和袖状胃切除术（SG）介导体重的定量变化和体成分的定性改变：一项 5 年研究。
Biliopancreatic Diversion (BPD), Long Common Limb Revisional Biliopancreatic Diversion (BPD + LCL-R), Roux-en-Y Gastric Bypass [RYGB] and Sleeve Gastrectomy (SG) mediate differential quantitative changes in body weight and qualitative modifications in body composition: a 5-year study.
机构信息
Dipartimento Di Chirurgia, IRCCS Multimedica, Milan, Italy.
Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy.
出版信息
Acta Diabetol. 2022 Jan;59(1):39-48. doi: 10.1007/s00592-021-01777-9. Epub 2021 Aug 28.
AIMS
Bariatric surgeries induce profound weight loss (decrease in body mass index, BMI), through a decrease in fat mass (FM) and to a much lesser degree of fat-free mass (FFM). Some reports indicate that the weight which is lost after gastric bypass (RYGB) and sleeve gastrectomy (SG) is at least partially regained 2 years after surgery. Here we compare changes in BMI and body composition induced by four bariatric procedures in a 5 years follow-up study.
METHODS
We analyzed retrospectively modifications in BMI, FM and FFM obtained through Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion (BPD) and a long common limb revisional biliopancreatic diversion (reduction of the gastric pouch and long common limb; BPD + LCL-R). Patients were evaluated at baseline and yearly for 5 years. Of the whole cohort of 565 patients, a subset of 180 patients had all yearly evaluations, while the remaining had incomplete evaluations. Setting University Hospital.
RESULTS
In a total of 180 patients evaluated yearly for 5 years, decrease in BMI and FM up to 2 years was more rapid with RYGB and SG than BPD and BPD + LCL-R; with RYGB and SG both BMI and FM slightly increased in the years 3-5. At 5 years, the differences were not significant. When analysing the differences between 2 and 5 years, BPD + LCL-R showed a somewhat greater effect on BMI and FM than RYGB, BPD and SG. Superimposable results were obtained when the whole cohort of 565 patients with incomplete evaluation was considered.
CONCLUSIONS
All surgeries were highly effective in reducing BMI and fat mass at around 2 years; with RYGB and SG both BMI and FM slightly increased in the years 3-5, while BPD and BPD + LCL-R showed a slight further decreases in the same time interval.
目的
减重手术通过减少脂肪量（FM）并在较小程度上减少去脂体重（FFM），从而引起明显的体重减轻（体重指数下降）。一些报告表明，胃旁路术（RYGB）和袖状胃切除术（SG）后的体重至少在手术后 2 年内部分恢复。在这里，我们比较了四种减重手术在 5 年随访研究中引起的 BMI 和身体成分的变化。
方法
我们回顾性分析了通过 Roux-en-Y 胃旁路术（RYGB）、袖状胃切除术（SG）、胆胰分流术（BPD）和长共同肠段修正胆胰分流术（缩小胃袋和长共同肠段；BPD+LCL-R）获得的 BMI、FM 和 FFM 的变化。患者在基线和每年进行评估，为期 5 年。在整个 565 例患者队列中，有 180 例患者每年进行了所有评估，而其余患者的评估不完整。
结果
在总共 180 例患者中，每年评估 5 年，与 BPD 和 BPD+LCL-R 相比，RYGB 和 SG 在前 2 年内 BMI 和 FM 的下降速度更快；在第 3-5 年，RYGB 和 SG 两者的 BMI 和 FM 都略有增加。5 年后，差异无统计学意义。当分析 2 年和 5 年之间的差异时，与 RYGB、BPD 和 SG 相比，BPD+LCL-R 对 BMI 和 FM 的影响略大。当考虑到不完整评估的 565 例患者的整个队列时，获得了可叠加的结果。
结论
所有手术在大约 2 年内都非常有效地降低 BMI 和脂肪量；RYGB 和 SG 在第 3-5 年两者的 BMI 和 FM 都略有增加，而 BPD 和 BPD+LCL-R 在同一时间间隔内显示出轻微的进一步下降。
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