Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
General Surgery Department, Beijing Youan Hospital, Capital Medical University, Beijing, China.
World J Surg. 2022 May;46(5):1122-1133. doi: 10.1007/s00268-021-06382-z. Epub 2022 Mar 11.
With the global pandemic of obesity and nonalcoholic fatty liver disease (NAFLD), the incidence of cirrhosis associated with nonalcoholic steatohepatitis (NASH) has greatly increased. This study aimed to evaluate the efficacy and safety of bariatric surgery in obese cirrhotic patients.
PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Effectiveness outcomes were weight loss, remission of comorbidities, and improvement in liver function. Safety outcomes were procedural complications and mortality.
A total of 15 studies were included in this meta-analysis. Patients with compensated cirrhosis lost weight significantly after surgery, and the percentage of excess weight loss was 60.44 (95% CI, 44.34 to 76.55). Bariatric surgery resulted in remission of NAFLD in 57.9% (95% CI, 27.5% to 88.3%), T2DM in 58.4% (95% CI, 48.4% to 68.4%), hypertension in 53.1% (95% CI, 43% to 63.3%), dyslipidemia in 59.8% (95% CI, 41.1% to 78.5%) of patients with cirrhosis. Bariatric surgery reduced the levels of alanine aminotransferase and aspartate aminotransferase. The incidence of surgical complications in patients with cirrhosis was about 19.2% (95% CI, 11.7% to 26.6%), which was higher than that in patients without cirrhosis (OR 2.67 [95% CI, 1.26 to 5.67]). Patients with cirrhosis had an overall mortality rate of 1.3%, and the mortality rates for compensated cirrhosis and decompensated cirrhosis were 0.9% and 18.2%, respectively.
Bariatric surgery is effective for weight loss, remission of comorbidities, and reversal of liver damage. Although cirrhotic patients have a higher risk of complications and death, bariatric surgery is relatively safe for well-compensated cirrhosis.
随着肥胖和非酒精性脂肪性肝病（NAFLD）的全球流行，非酒精性脂肪性肝炎（NASH）相关肝硬化的发病率大大增加。本研究旨在评估减肥手术治疗肥胖性肝硬化患者的疗效和安全性。
检索 PubMed、EMBASE 和 Cochrane Library 中的相关研究。有效性结果为体重减轻、合并症缓解和肝功能改善。安全性结果为手术并发症和死亡率。
共有 15 项研究纳入本 meta 分析。代偿性肝硬化患者术后体重显著减轻，多余体重减轻率为 60.44%（95%CI，44.34%至 76.55%）。减肥手术使 57.9%（95%CI，27.5%至 88.3%）的患者 NAFLD 缓解，58.4%（95%CI，48.4%至 68.4%）的患者 2 型糖尿病缓解，53.1%（95%CI，43%至 63.3%）的患者高血压缓解，59.8%（95%CI，41.1%至 78.5%）的患者血脂异常缓解。减肥手术降低了丙氨酸氨基转移酶和天冬氨酸氨基转移酶的水平。肝硬化患者手术并发症的发生率约为 19.2%（95%CI，11.7%至 26.6%），高于无肝硬化患者（OR 2.67[95%CI，1.26 至 5.67]）。肝硬化患者总的死亡率为 1.3%，代偿性肝硬化和失代偿性肝硬化的死亡率分别为 0.9%和 18.2%。
减肥手术对体重减轻、合并症缓解和肝功能逆转有效。虽然肝硬化患者并发症和死亡的风险较高，但对于代偿良好的肝硬化，减肥手术相对安全。
