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减重手术后肾结石的发病率:比较 Roux-en-Y 胃旁路术和袖状胃切除术。

Incidence of Kidney Stones After Bariatric Surgeries: Comparing Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

机构信息

Division of Gastroenterology, Hepatology, and Nutrition, UPMC, Mezzanine Level, C-Wing, PUH, 200 Lothrop St, Pittsburgh, PA, 15213, USA.

Department of Medicine, University Hospitals, Cleveland, OH, USA.

出版信息

J Gastrointest Surg. 2023 Nov;27(11):2336-2341. doi: 10.1007/s11605-023-05849-9. Epub 2023 Oct 2.

Abstract

INTRODUCTION/PURPOSE: The two most common procedures performed to treat obesity are Roux-En-Y gastric bypass (RNYGB) and laparoscopic sleeve gastrectomy (LSG). Due to changes in enteric absorption, bariatric surgery increases rates of nephrolithiasis. As population-based data are limited, we aimed to compare the incidence of kidney stones after RNYGB and LSG.

MATERIALS AND METHODS

We queried Explorys (Cleveland, OH), a database that aggregated data from 26 healthcare systems. We identified patients who were newly diagnosed with nephrolithiasis 3, 6, and 12 months after their RNYGB or LSG. Additionally, a multivariate analysis was conducted to investigate the association of nephrolithiasis with RNYGB as compared to LSG. This analysis adjusted for other risk factors, including age above 65, male gender, Caucasian race, diabetes mellitus, hypertension, primary hyperparathyroidism, gout, and obesity.

RESULTS

From 1999 to 2019, there were 11,480 patients who underwent RNYGB and 22,770 patients who underwent LSG. The incidence of nephrolithiasis in the RNYGB cohort at all three time points was higher than in the LSG cohort (3 months, 7.1% vs. 2.4%; 6 months, 6.6% vs. 2.0%; 1 year, 5.8% vs. 1.4%; P < 0.001). After the multivariate analysis, it was found that, though both RNYGB and LSG were independently associated with the development of nephrolithiasis, the risk of nephrolithiasis was higher in those who underwent RNYGB compared to those who underwent LSG (OR 1.594, 95% CI 1.494 to 1.701, P < 0.001).

CONCLUSION

RNYGB is associated with a higher risk of nephrolithiasis when compared to LSG.

摘要

简介/目的:治疗肥胖症最常见的两种手术是 Roux-en-Y 胃旁路术(RNYGB)和腹腔镜袖状胃切除术(LSG)。由于肠道吸收的变化,减重手术会增加肾结石的发病率。由于基于人群的数据有限,我们旨在比较 RNYGB 和 LSG 后肾结石的发生率。

材料和方法

我们在 Explorys(俄亥俄州克利夫兰)进行了查询,这是一个聚合了 26 个医疗系统数据的数据库。我们确定了在 RNYGB 或 LSG 后 3、6 和 12 个月新诊断为肾结石的患者。此外,我们还进行了多变量分析,以调查肾结石与 RNYGB 的相关性,与 LSG 相比。该分析调整了其他风险因素,包括年龄大于 65 岁、男性、白种人、糖尿病、高血压、原发性甲状旁腺功能亢进症、痛风和肥胖。

结果

1999 年至 2019 年,有 11480 例患者接受了 RNYGB 手术,22770 例患者接受了 LSG 手术。在所有三个时间点,RNYGB 组的肾结石发生率均高于 LSG 组(3 个月时为 7.1%比 2.4%;6 个月时为 6.6%比 2.0%;1 年时为 5.8%比 1.4%;P<0.001)。在多变量分析后发现,尽管 RNYGB 和 LSG 均与肾结石的发生独立相关,但与接受 LSG 相比,接受 RNYGB 的患者肾结石的风险更高(OR 1.594,95%CI 1.494 至 1.701,P<0.001)。

结论

与 LSG 相比,RNYGB 与肾结石的风险增加相关。

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