Meta-analysis: Surgical treatment of obesity
Meta-analysis: Surgical treatment of obesity
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DOI：
10.7326/0003-4819-142-7-200504050-00013
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发表时间：
2005-04-05
影响因子：
39.2
通讯作者：
Shekelle, PG
中科院分区：
文献类型：
--
作者：
Maggard, MA;Shugarman, LR;Shekelle, PG
背景：关于手术减肥的有效性和由此带来的健康相关结果的改善存在争议。目的：对肥胖手术治疗的有效性和不良事件进行荟萃分析。数据来源：MEDLINE， EMBASE， Cochrane对照试验注册和系统综述。研究选择：随机对照试验；观察性研究;以及肥胖症手术治疗的病例系列报道。资料提取：有关研究设计、程序、人群、合并症和不良事件的信息。数据综合：作者评估了147项研究。其中，89例用于体重减轻分析，134例用于死亡率分析，128例用于并发症分析。作者确定了一项大型匹配队列分析，报告了平均体重指数（BMI）为40 kg/m(2)或更高的个体，手术比药物治疗更能减轻体重。手术导致体重减轻20至30公斤，这种情况维持了长达10年，并伴有一些合并症的改善。对于bmi在35 ~ 39 kg/m(2)，病例序列数据强烈支持手术优势，但不能被认为是结论性的。胃旁路手术比胃成形术更能减轻体重。目前使用的减肥手术（胃旁路术、腹腔镜可调节胃带、垂直带状胃成形术和胆管转移和转换）的总死亡率低于1%。大约20%的病例发生不良事件。腹腔镜入路比开放入路的伤口并发症更少。局限性：只有少数对照试验可用于分析。研究之间存在异质性，可能存在发表偏倚。结论：对于体重指数为40 kg/m(2)或更高的患者，手术比非手术治疗更有效地减轻体重和控制一些合并症。需要更多的数据来确定手术相对于非手术治疗对不严重肥胖的人的疗效。手术方法在疗效和并发症发生率上有所不同。
Background: controversy exists regarding the effectiveness of surgery for weight loss and the resulting improvement in healthrelated outcomes.Purpose: To perform a meta-analysis of effectiveness and adverse events associated with surgical treatment of obesity.Data Sources: MEDLINE, EMBASE, Cochrane Controlled Trials Register, and systematic reviews. Study Selection: Randomized, controlled trials; observational studies; and case series reporting on surgical treatment of obesity.Data Extraction: Information about study design, procedure, population, comorbid conditions, and adverse events.Data Synthesis: The authors assessed 147 studies. Of these, 89 contributed to the weight loss analysis, 134 contributed to the mortality analysis, and 128 contributed to the complications analysis. The authors identified 1 large, matched cohort analysis that reported greater weight loss with surgery than with medical treatment in individuals with an average body mass index (BMI) of 40 kg/m(2) or greater. Surgery resulted in a weight loss of 20 to 30 kg, which was maintained for up to 10 years and was accompanied by improvements in some comorbid conditions. For BMIs of 35 to 39 kg/m(2), data from case series strongly support superiority of surgery but cannot be considered conclusive. Gastric bypass procedures result in more weight loss than gastroplasty. Bariatric procedures in current use (gastric bypass, laparoscopic adjustable gastric band, vertical banded gastroplasty, and biliopancreatic diversion and switch) have been performed with an overall mortality rate of less than 1%. Adverse events occur in about 20% of cases. A laparoscopic approach results in fewer wound complications than an open approach.Limitations: only a few controlled trials were available for analysis. Heterogeneity was seen among studies, and publication bias is possible.Conclusions: Surgery is more effective than nonsurgical treatment for weight loss and control of some comorbid conditions in patients with a BMI of 40 kg/m(2) or greater. More data are needed to determine the efficacy of surgery relative to nonsurgical therapy for less severely obese people. Procedures differ in efficacy and incidence of complications.