Use and Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass: Analysis of the American College of Surgeons NSQIP
Use and Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass: Analysis of the American College of Surgeons NSQIP
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DOI：
10.1016/j.jamcollsurg.2015.01.059
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发表时间：
2015-05-01
影响因子：
5.2
通讯作者：
Nguyen, Ninh T.
中科院分区：
文献类型：
--
作者：
Young, Monica T.;Gebhart, Alana;Nguyen, Ninh T.
背景：腹腔镜袖状胃切除术在美国越来越受欢迎。然而，很少有研究探讨袖状胃切除术的结果相比，“金标准”减肥手术：Roux-en-Y gastric bypass.Study设计：使用美国外科医师学会国家外科手术质量改进计划数据库，临床数据，获得所有患者谁接受腹腔镜袖状胃切除术或腹腔镜胃旁路手术在2010年和2011年之间。主要结果的措施是风险调整后的30天严重发病率和mortality.RESULTS：我们分析了24,117例接受腹腔镜袖状胃切除术或腹腔镜胃旁路术治疗病态肥胖的患者。胃旁路术占79.5%，袖状胃切除术占20.5%;袖状胃切除术病例比例从2010年的14.6%增加到2011年的25.8%。在单因素分析中，袖状胃切除术的平均手术时间较短（101 vs 133分钟，p < 0.01），需要输血的失血率较低（0.6%对1.5%，P < 0.01），深部伤口感染率较低（0.06% vs 0.20%，p = 0.05），严重发病率较低术后30天再手术率（1.6%vs2.5%，p <0.01），但深静脉血栓形成率（0.47%vs0.21%，p <0.01）高于术前。与袖状胃切除术相比，胃旁路术患者有更高的风险调整后的30天严重发病率（比值比[OR] 1.32; 95% CI 1.11至1.56，p < 0.01）。年龄较大、BMI较高、吸烟或患有高血压的患者发生严重疾病的风险显著较高。两组的30天死亡率相似（袖状胃切除术为0.10%，分流术为0.15%）。结论：腹腔镜袖状胃切除术的使用在全国范围内正在增加。与腹腔镜胃旁路术相比，腹腔镜袖状胃切除术的30天风险调整严重发病率较低，30天死亡率相当。(C)2015年美国外科医生学会
BACKGROUND: Laparoscopic sleeve gastrectomy is gaining popularity in the United States. However, few studies have examined outcomes of sleeve gastrectomy compared with those of the "gold standard" bariatric operation: Roux-en-Y gastric bypass.STUDY DESIGN: Using the American College of Surgeons National Surgical Quality Improvement Program database, clinical data were obtained for all patients who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass between 2010 and 2011. Main outcomes measures were risk-adjusted 30-day serious morbidity and mortality.RESULTS: We analyzed 24,117 patients who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass for the treatment of morbid obesity. Gastric bypass comprised 79.5% of cases and sleeve gastrectomy comprised 20.5%; the proportion of sleeve gastrectomy cases increased from 14.6% in 2010 to 25.8% in 2011. On univariate analysis, sleeve gastrectomy had a shorter mean operative time (101 vs 133 minutes, p < 0.01), a lower rate of blood loss requiring transfusion (0.6% vs 1.5%, p < 0.01), a lower rate of deep wound infections (0.06% vs 0.20%, p = 0.05), lower serious morbidity rate (3.8% vs 5.8%, p < 0.01), and 30-day reoperation rate (1.6% vs 2.5%, p < 0.01), but a higher rate of deep venous thrombosis (0.47% vs 0.21%, p < 0.01). Compared with sleeve gastrectomy, gastric bypass patients had higher risk-adjusted 30-day serious morbidity (odds ratio [OR] 1.32; 95% CI1.11 to 1.56, p < 0.01). Patients who were older, had higher BMI, smoked, or had hypertension were at significantly greater risk of serious morbidity. The 30-day mortality was similar between groups (0.10% for sleeve vs 0.15% for bypass).CONCLUSIONS: Use of laparoscopic sleeve gastrectomy is increasing on a national level. Compared with laparoscopic gastric bypass, laparoscopic sleeve gastrectomy is associated with lower 30-day riskadjusted serious morbidity and equivalent 30-day mortality. (C) 2015 by the American College of Surgeons