Roux-en-Y 胃旁路术后 15 年的综合结果。

Comprehensive outcomes after Roux-en-Y gastric bypass with a near-complete 15-year follow-up.

机构信息

Department of Surgery, Mayo Clinic, Rochester, MN.

Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.

出版信息

Surgery. 2024 Sep;176(3):586-594. doi: 10.1016/j.surg.2024.02.035. Epub 2024 May 19.

DOI:10.1016/j.surg.2024.02.035

PMID:38769035

Abstract

BACKGROUND

Laparoscopic Roux-en-Y gastric bypass has a well-established safety and efficacy profile in the short and mid-term. Long-term outcomes remain limited in the literature, especially for follow-up periods of >10 years. The purpose of the study is to evaluate the long-term durability and safety of laparoscopic Roux-en-Y gastric bypass over a near-complete 15-year follow-up.

METHODS

This is a single-center retrospective cohort study of patients who underwent primary laparoscopic Roux-en-Y gastric bypass between 2008 and 2009 with ≥14-year follow-up. Data collected and analyzed were weight loss, obesity-related medical condition resolution and recurrence, weight recurrence, complication rate, and mortality rate.

RESULTS

A total of 264 patients were included. Patients were predominantly female (81.8%), and the mean age and preoperative body mass index were 48.5 ± 12.2 years and 44.9 ± 7.3 kg/m, respectively. The maximum mean percentage total weight loss achieved at 1 year was 31.5% ± 5.7% and was consistently >20% throughout follow-up. Sustained resolution of obesity-related medical conditions was achieved with a remission rate of 60.8% for type 2 diabetes mellitus, 46.7% for denoted dyslipidemia, and 40% for hypertension. Obesity-related medical condition recurrence was observed with a recurrence rate of 24.1% for type 2 diabetes mellitus, 17.9% for hypertension, and 14.8% for denoted dyslipidemia. Significant factors associated with weight loss were maximum percentage total weight loss and preoperative type 2 diabetes mellitus. Over 15 years, the weight recurrence rate was 51.1%, with predictors of higher preoperative body mass index and preoperative type 2 diabetes mellitus.

CONCLUSION

Laparoscopic Roux-en-Y gastric bypass provides sustainable weight loss over a 15-year period, with consistent long-term weight-loss outcomes and resolution of obesity-related medical conditions sustained for ≥10 years after surgery.

摘要

背景

腹腔镜 Roux-en-Y 胃旁路术在短期和中期具有良好的安全性和疗效。长期结果在文献中仍然有限，特别是随访时间超过 10 年。本研究的目的是评估腹腔镜 Roux-en-Y 胃旁路术在近 15 年的随访中的长期耐久性和安全性。

方法

这是一项单中心回顾性队列研究，纳入了 2008 年至 2009 年间接受腹腔镜 Roux-en-Y 胃旁路术且随访时间≥14 年的患者。收集和分析的数据包括体重减轻、肥胖相关医疗状况的解决和复发、体重复发、并发症发生率和死亡率。

结果

共纳入 264 例患者。患者主要为女性（81.8%），平均年龄和术前体重指数分别为 48.5 ± 12.2 岁和 44.9 ± 7.3kg/m²。术后 1 年最大平均总体重减轻率为 31.5%±5.7%，且在整个随访期间持续保持在>20%。肥胖相关医疗状况的持续缓解率为 60.8%的 2 型糖尿病、46.7%的指定血脂异常和 40%的高血压。观察到肥胖相关医疗状况的复发，2 型糖尿病的复发率为 24.1%、高血压为 17.9%、指定血脂异常为 14.8%。与体重减轻相关的显著因素为最大总体重减轻率和术前 2 型糖尿病。术后 15 年内，体重复发率为 51.1%，术前体重指数和术前 2 型糖尿病为其预测因素。