Variations of weight loss following gastric bypass and gastric band.
Variations of weight loss following gastric bypass and gastric band.
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胃绕道手术和胃束带术后体重减轻的变化。
DOI：
10.1097/sla.0b013e3181820cbc
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发表时间：
2008
影响因子：
9
通讯作者：
Rush,AJohn
中科院分区：
文献类型：
--
作者：
Puzziferri,Nancy;Nakonezny,PaulA;Livingston,EdwardH;Carmody,ThomasJ;Provost,DavidA;Rush,AJohn
目的：比较和描述胃旁路术和胃束带术的减肥结果，以确定个体患者中过量减肥（EWL）的变化，起效时间和严重肥胖adults.Summary背景数据：胃旁路术和胃束带术是美国最常见的肥胖手术，但很少有报道比较这2个procedures.Methods：患者（N= 1733，年龄18-65岁）符合美国国立卫生研究院肥胖手术标准，并在1997年3月至2006年11月期间接受胃旁路术或胃束带术。旁路与带的选择基于患者/外科医生的讨论。可评价样本包括1518例患者。EWL的百分比在2年内进行了评估。成功的体重减轻被先验地定义为在4个6个月的术后测量期中的每一个中EWL ≥ 40%。分析包括混合模型和重复测量的广义估计方程（GEE）模型。比值比和描述性分析也provided.Results：胃旁路术与个体差异较小的体重减轻比胃束带。两种手术均与显著的EWL获益相关（治疗组效应P< 0.0001），但它们在起效时间方面存在差异（治疗组×周期相互作用效应P< 0.0001）。胃旁路术的平均EWL在每个测量期（6、12、18、24个月）均大于胃束带术（P< 0.0001）。此外，在每个治疗组（旁路和带）的每个术后测量期，术前体重指数（BMI）≤ 50 kg/m2的患者的平均EWL大于术前BMI> 50 kg/m2的患者（P< 0.0001）。胃旁路术与术后6个月测量期间至少40% EWL的可能性相关（GEE，P< 0.0001）。第6、12、18和24个月的比值比估计值分别为18.2、20.6、15.5和9.1。尽管有这些临床意义的结果差异，几乎所有（≥ 93%）旁路和带患者有≥ 40%EWL在6，12，或18个月后保持至少在2 years.Conclusions这一水平的成功：胃旁路产生更快，更大，更一致的EWL在个人超过2年的术后期间比胃带。
Objective:To compare and describe the weight loss outcomes from gastric bypass and gastric band so as to define the variation of excess weight loss (EWL) among individual patients, the time to onset of effect, and the durability of weight loss in severely obese adults.Summary Background Data:Gastric bypass and gastric band are the most common operations for obesity performed in the United States, but few reports have compared these 2 procedures.Methods:Patients (N= 1733, aged 18–65 years) met National Institutes of Health criteria for obesity surgery and underwent either gastric bypass or gastric band between March 1997 and November 2006. The selection of bypass versus band was based on patient/surgeon discussion. The evaluable sample consisted of 1518 patients. The percentage of EWL was assessed over 2 years. Successful weight loss was defined a priori as≥ 40% EWL in each of four 6-month postoperative measurement periods. The analyses included a mixed model and generalized estimating equation (GEE) model with repeated measures. Odds ratios and descriptive analyses were also provided.Results:Gastric bypass was associated with less individual variation in weight loss than gastric band. Both procedures were associated with a significant EWL benefit (Treatment Group effect P< 0.0001), but they differed in terms of time to effect (Treatment Group× Period interaction effect P< 0.0001). The mean EWL for gastric bypass was greater at each measurement period (6, 12, 18, 24 months) compared with gastric band (P< 0.0001). Furthermore, at each of the postoperative measurement periods within each treatment group (bypass and band), the mean EWL was greater for those who had preoperative body mass index (BMI)≤ 50 kg/m 2 than for those who had preoperative BMI> 50 kg/m 2 (P< 0.0001). Gastric bypass was consistently associated with a greater likelihood of at least a 40% EWL in each of the 6-month postoperative measurement periods (GEE, P< 0.0001). The odds ratio estimates at months 6, 12, 18, and 24 were 18.2, 20.6, 15.5, and 9.1, respectively. Despite these clinically meaningful outcome differences, nearly all (≥ 93%) bypass and band patients who had≥ 40% EWL at 6, 12, or 18 months postoperatively maintained at least this level of success at 2 years.Conclusions:Gastric bypass produced more rapid, greater, and more consistent EWL across individuals over a 2-year postoperative period than gastric band.