巴西队列中胃旁路手术和袖状胃切除术后八年随访：体重变化轨迹和健康结果
Eight Year Follow-Up After Gastric Bypass and Sleeve Gastrectomy in a Brazilian Cohort: Weight Trajectory and Health Outcomes.
作者信息
Lins de Souza Salerno Marianna, Garcia Soares Leães Rech Carolina, Bortoluzzi Escobar da Silva Pedro, Weston Antonio Carlos, de Carli Luis Alberto, Pereira-Lima Julia Fernanda
机构信息
Graduate Program in Pathology at the Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil.
Obesity Treatment Center, Hospital Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 155 - Independência, Porto Alegre, RS, 90035-074, Brazil.
出版信息
Obes Surg. 2024 Dec;34(12):4452-4458. doi: 10.1007/s11695-024-07557-y. Epub 2024 Oct 26.
INTRODUCTION
Despite Sleeve Gastrectomy (SG) being the most commonly performed bariatric surgery today, studies with over 5 years of follow-up show that patients undergoing SG have inferior weight loss compared to those undergoing Roux-en-Y gastric bypass (RYGB). The aim of this study was to examine differences in weight loss and the prevalence of weight regain between SG and RYGB up to 8 years after surgery.
METHODS
Retrospective study including adult patients undergoing SG or RYGB between 2015 and 2018 at a tertiary center in Brazil. We evaluate the weight trajectory and pre- and postoperative behavior of type 2 diabetes (T2D), hypertension, and dyslipidemia. Differences betwen variables were tested using Student t-test, Mann-Whitney U, Pearson's chi-square or Fisher's exact test as appropriate. The level of significance adopted was p < 0,005.
RESULTS
Among 591 patients (40 ± 10 years; baseline body mass index 41.7 [IQR 39.1-45]; 83% women), 327 underwent RYGB (55%) and 264 SG (45%). Preoperatively, 14% had T2D, 40% hypertension, and 53% dyslipidemia. The mean total percentage of weight loss was higher in the RYGB group after 8 years: 32% compared to 19% after SG (difference 13%, p < 0.004). At 8 years, weight regain was also lower in RYGB (23%) compared to SG (39%) (p < 0.001). At 5 years postoperatively, the remission rates for T2D, hypertension, and dyslipidemia were 63%, 42%, and 51%, respectively, among the patients who remained in follow-up.
CONCLUSIONS
Patients undergoing RYGB showed greater weight loss and less weight regain 8 years after bariatric surgery compared to those undergoing SG.
引言
尽管袖状胃切除术（SG）是目前最常施行的减肥手术，但超过5年随访的研究表明，接受SG手术的患者与接受Roux-en-Y胃旁路术（RYGB）的患者相比，体重减轻效果较差。本研究的目的是探讨SG和RYGB术后长达8年的体重减轻差异及体重反弹发生率。
方法
一项回顾性研究，纳入2015年至2018年在巴西一家三级中心接受SG或RYGB手术的成年患者。我们评估了体重变化轨迹以及2型糖尿病（T2D）、高血压和血脂异常的术前及术后情况。根据情况，使用学生t检验、曼-惠特尼U检验、皮尔逊卡方检验或费舍尔精确检验来检验变量之间的差异。采用的显著性水平为p < 0.005。
结果
在591例患者中（年龄40±10岁；基线体重指数41.7[四分位间距39.1 - 45]；83%为女性），327例接受了RYGB手术（55%），264例接受了SG手术（45%）。术前，14%患有T2D，40%患有高血压，53%患有血脂异常。8年后，RYGB组的平均总体重减轻百分比更高：为32%，而SG组为19%（差异13%，p < 0.004）。在8年时，RYGB组的体重反弹率（23%）也低于SG组（39%）（p < 0.001）。术后5年，仍在随访的患者中，T2D、高血压和血脂异常的缓解率分别为63%、42%和51%。
结论
与接受SG手术的患者相比，接受RYGB手术的患者在减肥手术后8年体重减轻更多，体重反弹更少。
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