Mason E E, Tang S, Renquist K E, Barnes D T, Cullen J J, Doherty C, Maher J W
Department of Surgery, Iowa City, Iowa, USA.
Obes Surg. 1997 Jun;7(3):189-97. doi: 10.1381/096089297765555719.
The International (formerly National) Bariatric Surgery Registry began collecting data in January 1986. The aim of this study was to examine changes in the practice of surgical treatment of severe obesity that occurred during the decade of 1986 through 1995, as observed in the IBSR data.
All data submitted to the IBSR during the decade were transferred to the IBM mainframe computer for analysis. Characteristics of operative type populations were compared over time using analysis of variance (ANOVA) for age, body mass index (BMI), operative weight and Chi-square (chi2) test for gender.
There has been a steady increase over the decade in mean patient weight. The operations used have changed from predominantly 'simple' operations to more frequent use of 'complex' operations. Within the categories of 'simple' and 'complex', an increase in the variety of operations occurred. As a group, patients with 'simple' operations have been heavier, more often male and public pay patients than those who have undergone 'complex' operations. One year weight loss was greater for Roux-en-Y gastric bypass (RGB) than vertical banded gastroplasty (VBG), but follow-up rates were too low to study the relative merits of the operations used. The reported incidence of operative mortality and serious complications (leak with peritonitis, abscess and pulmonary embolism) remained low.
These observations and their implications can be summarized in three statements which relate to action for improved patient care in the beginning of the new century: (1) increasing weight of candidates for surgical treatment during this decade indicates the need for earlier use of operative treatment before irreversible complications of obesity can develop; (2) low risk of obesity surgery, decreasing postoperative hospital stay, and early weight control support the continued and increased use of surgical treatment; (3) continued widespread use of both 'simple' and 'complex' operations with increased modifications of standard RGB and VBG procedures emphasizes the need for standardized long-term data and analyses regarding both weight control and postoperative side-effects.
国际（原国家）肥胖症手术登记处于1986年1月开始收集数据。本研究的目的是通过国际肥胖症手术登记处（IBSR）的数据，研究1986年至1995年这十年间严重肥胖症手术治疗实践的变化。
将该十年期间提交给IBSR的所有数据转移到IBM大型计算机进行分析。使用方差分析（ANOVA）比较不同时间段手术类型人群的年龄、体重指数（BMI）、手术体重等特征，并使用卡方（chi2）检验比较性别特征。
在这十年间，患者的平均体重稳步增加。所采用的手术方式已从主要的“简单”手术转变为更频繁地使用“复杂”手术。在“简单”和“复杂”类别中，手术种类均有所增加。总体而言，接受“简单”手术的患者比接受“复杂”手术的患者体重更重，男性更多，且公费患者更多。Roux-en-Y胃旁路术（RGB）的一年体重减轻幅度大于垂直捆绑胃成形术（VBG），但随访率过低，无法研究所用手术的相对优缺点。报告的手术死亡率和严重并发症（伴有腹膜炎的渗漏、脓肿和肺栓塞）发生率仍然较低。
这些观察结果及其影响可以归纳为三条陈述，这与新世纪初改善患者护理的行动相关：（1）这十年间手术治疗候选者体重增加，表明需要在肥胖症出现不可逆并发症之前更早地使用手术治疗；（2）肥胖症手术风险低、术后住院时间缩短以及早期体重控制，支持继续并增加手术治疗的使用；（3）“简单”和“复杂”手术的持续广泛应用，以及标准RGB和VBG手术的改良增加，强调需要关于体重控制和术后副作用的标准化长期数据及分析。
