Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity
Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity
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DOI：
10.1007/s00464-005-0134-5
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发表时间：
2006-06-01
影响因子：
3.1
通讯作者：
Schauer, P.
中科院分区：
文献类型：
--
作者：
Cottam, D.;Qureshi, F. G.;Schauer, P.
背景：手术治疗高危、高体质指数（BMI） （bbb60）患者的肥胖仍然是一个挑战。这些患者的主要发病率和死亡率分别接近38%和6%。为了获得更有利的结果，我们采用了两阶段的方法来治疗这类高危患者。本研究评估了我们使用该技术的初步结果。方法：在本研究中，2002年1月至2004年2月期间，患者接受了腹腔镜袖胃切除术（LSG）作为第一阶段。在获得显著的体重减轻和合并症减少后，这些患者接着进行第二阶段，腹腔镜Roux-en-Y胃旁路术（LRYGBP）。结果：在此期间，126例患者接受了LSG（53%为女性）。平均年龄49.5 +/- 0.9岁，平均BMI为65.3 +/- 0.8（45-91）。手术风险评估确定42%为美国麻醉医师协会身体状态评分（ASA） III级，52%为ASA IV级。每名患者共病的平均数量为9.3 +/- 0.3，中位数为10（范围3-17）。有一例远端死亡，主要并发症发生率为13%。LSG术后1年的平均超重率为46%。36例平均BMI为49.1 +/- 1.3（超重体重减轻，EWL, 38%）的患者患有二期LRYGBP。该组的平均合并症数为6.4 +/- 0.1（从9例减少）。在LRYGB时，大多数患者的ASA级别已经下降。第一阶段和第二阶段的平均时间间隔为12.6±0.8个月。平均和中位住院时间分别为3±1.7天和2.5天（范围2-7天）。无死亡病例，主要并发症发生率为8%。结论：对于寻求减肥手术的高危患者，LSG + LRYGBP是一种安全有效的手术方式。
Background: The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (> 60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38% and 6%, respectively. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such high-risk patients. This study evaluates our initial outcomes with this technique.Methods: In this study, patients underwent laparoscopic sleeve gastrectomy (LSG) as a first stage during the period January 2002-February 2004. After achieving significant weight loss and reduction in co-morbidities, these patients then proceeded with the second stage, laparoscopic Roux-en-Y gastric bypass (LRYGBP).Results: During this time, 126 patients underwent LSG (53% female). The mean age was 49.5 +/- 0.9 years, and the mean BMI was 65.3 +/- 0.8 (range 45-91). Operative risk assessment determined that 42% were American Society of Anesthesiologists physical status score (ASA) III and 52% were ASA IV. The mean number of comorbid conditions per patient was 9.3 +/- 0.3 with a median of 10 (range 3-17). There was one distant mortality and the incidence of major complications was 13%. Mean excess weight after LSG at I year was 46%. Thirty-six patients with a mean BMI of 49.1 +/- 1.3 (excess weight loss, EWL, 38%) had the second-stage LRYGBP. The mean number of co-morbidities in this group was 6.4 +/- 0.1 (reduced from 9). The ASA class of the majority of patients had been downstaged at the time of LRYGB. The mean time interval between the first and second stages was 12.6 +/- 0.8 months. The mean and median hospital stays were 3 +/- 1.7 and 2.5 (range 2-7) days, respectively. There were no deaths, and the incidence of major complications was 8%.Conclusion: The staging concept of LSG followed by LRYGBP is a safe and effective surgical approach for high-risk patients seeking bariatric surgery.