Roux-en-Y 胃旁路术与袖状胃切除术治疗肥胖症的围产期不良结局：系统评价。
Adverse perinatal outcomes after Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy: a systematic review.
机构信息
Department of Obstetrics & Gynecology, Lund University and Skåne University Hospital, Malmö, 205 01, Sweden.
Obstetrics & Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
出版信息
BMC Pregnancy Childbirth. 2023 Aug 2;23(1):557. doi: 10.1186/s12884-023-05515-7.
BACKGROUND
Pregnancies occurring after bariatric surgery are associated with various perinatal complications. However, there may be differences in the type of perinatal complications occurring after different methods of bariatric surgery. The aim of the current study was to compare adverse perinatal outcomes in pregnant women following Roux-en-Y Gastric Bypass (RYGB) vs. Sleeve Gastrectomy (SG).
METHODS
A systematic database search was performed in PubMed, Embase, Scopus and CINAHL. Observational studies comparing perinatal outcomes post-bariatric (RYGB and SG) surgery to pregnancies without prior surgery were selected. Outcomes of interest were: maternal body mass index (BMI) at the time of conception, mode of delivery, time from surgery to conception, birth weight, gestational age and intrauterine fetal death. Article selection, risk of bias assessment and data extraction, were performed by two authors. The study protocol was published in its revised form in PROSPERO, registration number: CRD42021234480.
RESULTS
A total of 3201 records were extracted. After duplicates were removed, 3143 records were screened for inclusion. Six studies fitted the selection criteria, of which four studies were RYGB and two SG (1100 post-RYGB vs. 209 post-SG). For the included studies, higher incidence of both SGA (22.9%, 11.9%, 14.2%) and LGA (4.2%, 4.8%, 1.7%) in SG compared to Roux-en-Y (SGA: 8.8%, 7.7%, 11.5%, 8.3% and LGA: 3.4%, 0.7%) were observed. SG had a shorter surgery to conception interval as compared to RYGB. Risk of bias assessment was moderate to serious for the studies included in the review, with bias in selection of participants being the major reason.
CONCLUSION
Our systematic review demonstrated no major differences in BMI, mode of delivery, birthweight, gestational age, or rates of intrauterine death between women having undergone RYGB vs. SG. The rate of SGA and LGA births were higher in the SG group, but this group also had a shorter surgery to conception interval. Future studies are indicated to counsel women of reproductive age on the most appropriate type of bariatric surgery that is associated with the best perinatal outcomes.
背景
减肥手术后的妊娠与各种围产期并发症有关。然而，不同减肥手术方法后发生的围产期并发症类型可能存在差异。本研究的目的是比较 Roux-en-Y 胃旁路术（RYGB）与袖状胃切除术（SG）后孕妇不良围产结局。
方法
在 PubMed、Embase、Scopus 和 CINAHL 中进行系统数据库检索。选择比较减肥手术后（RYGB 和 SG）与无手术史妊娠的围产结局的观察性研究。感兴趣的结局为：受孕时母体体重指数（BMI）、分娩方式、手术至受孕时间、出生体重、孕龄和宫内胎儿死亡。两名作者进行了文章选择、偏倚风险评估和数据提取。该研究方案已在 PROSPERO 中以修订形式发布，注册号：CRD42021234480。
结果
共提取 3201 条记录。去除重复项后，对 3143 条记录进行了纳入筛选。符合选择标准的有 6 项研究，其中 4 项为 RYGB，2 项为 SG（1100 例 RYGB 后 vs. 209 例 SG 后）。对于纳入的研究，SG 中 SGA（22.9%、11.9%、14.2%）和 LGA（4.2%、4.8%、1.7%）的发生率均高于 Roux-en-Y（SGA：8.8%、7.7%、11.5%、8.3%和 LGA：3.4%、0.7%）。与 RYGB 相比，SG 的手术至受孕时间间隔较短。纳入研究的偏倚评估为中度至严重，主要偏倚为参与者选择偏倚。
结论
我们的系统评价显示，接受 RYGB 与 SG 的女性在 BMI、分娩方式、出生体重、孕龄或宫内死亡发生率方面无显著差异。SG 组 SGA 和 LGA 出生的发生率较高，但该组的手术至受孕时间间隔较短。需要进一步研究，以便向育龄妇女提供有关与最佳围产结局相关的最适当减肥手术类型的咨询。
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