可调胃束带与胃袖状切除术的长期匹配比较：体重减轻、生活质量、医院资源利用和患者报告的结果测量。
Long-Term Matched Comparison of Adjustable Gastric Banding Versus Sleeve Gastrectomy: Weight Loss, Quality of Life, Hospital Resource Use and Patient-Reported Outcome Measures.
机构信息
Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Commercial Rd, Prahran, 3004, Australia.
Centre for Obesity Research and Education (CORE), Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Prahran, 3004, Australia.
出版信息
Obes Surg. 2020 Jan;30(1):214-223. doi: 10.1007/s11695-019-04168-w.
BACKGROUND
Comparisons of bariatric procedures across a range of outcomes are required to better inform selection of procedures and optimally allocate health care resources.
AIMS
To determine differences in outcomes between laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) across nine outcome domains.
METHODS
Matched primary LSG or LAGB across age, weight and surgery date were recruited. Data were collected from a prospective database and patient-completed questionnaires.
RESULTS
Patients (n = 520) were well-matched (LAGB vs. LSG; age 41.8 ± 11.2 vs. 42.7 ± 11.7 years, p = 0.37; male 32.4% vs. 30.2%, p = 0.57; baseline weight 131.2 ± 30.5 vs. 131.0 ± 31.1 kg, p = 0.94). Follow-up rate was 95% at a mean of 4.8 years. LAGB attended more follow-up visits (21 vs. 13, p < 0.05). Mean total body weight loss was 27.7 ± 11.7% vs. 19.4 ± 11.1% (LSG vs. LAGB, p < 0.001). LAGB had more complications (23.8% vs. 10.8%, p < 0.001), re-operations (89 vs. 13, p < 0.001) and readmissions (87 vs. 32, p < 0.001). However, early post-operative complications were higher post-LSG (2.6 vs. 9.2%, p = 0.007). Length of stay (LOS) was higher post-LSG compared with LAGB (5.2 ± 10.9 vs. 1.5 ± 2.2 days, p < 0.001). LSG patients reported better quality of life (SF-36 physical component score 54.7 ± 7.9 vs. 47.7 ± 10.8, p = 0.002) and satisfaction (9.2 ± 1.9 vs. 8.4 ± 1.6, p = 0.001) and less frequent regurgitation (1.2 ± 1.2 vs. 0.7 ± - 1.1, p = 0.032) and dysphagia (2.0 ± 1.3 vs. 1.3 ± 1.6, p = 0.007).
CONCLUSION
This study showed high long-term follow-up rates in a large cohort of well-matched patients. Weight loss was greater with LSG. LAGB reported more re-operations and less satisfaction with the outcome. LOS was driven by patients with complications. This study has reinforced the need for comprehensive measurement of outcomes in bariatric surgery.
背景
为了更好地选择手术方案并优化医疗资源配置，需要对各种结果的减重手术进行比较。
目的
比较腹腔镜可调胃束带术（LAGB）和腹腔镜袖状胃切除术（LSG）在九个结果领域的差异。
方法
匹配年龄、体重和手术日期的原发性 LSG 或 LAGB 患者。数据来自前瞻性数据库和患者完成的问卷。
结果
患者（n=520）匹配良好（LAGB 与 LSG；年龄 41.8±11.2 岁与 42.7±11.7 岁，p=0.37；男性 32.4%与 30.2%，p=0.57；基线体重 131.2±30.5 千克与 131.0±31.1 千克，p=0.94）。平均随访 4.8 年时的随访率为 95%。LAGB 参加了更多的随访就诊（21 次与 13 次，p<0.05）。总体体重减轻率为 27.7±11.7%与 19.4±11.1%（LSG 与 LAGB，p<0.001）。LAGB 并发症更多（23.8%与 10.8%，p<0.001）、再次手术（89 次与 13 次，p<0.001）和再入院（87 次与 32 次，p<0.001）。然而，LSG 术后早期并发症发生率更高（2.6%与 9.2%，p=0.007）。LSG 的住院时间（LOS）长于 LAGB（5.2±10.9 天与 1.5±2.2 天，p<0.001）。LSG 患者报告的生活质量（SF-36 生理成分评分 54.7±7.9 分与 47.7±10.8 分，p=0.002）和满意度（9.2±1.9 分与 8.4±1.6 分，p=0.001）更高，反流（1.2±1.2 分与 0.7±1.1 分，p=0.032）和吞咽困难（2.0±1.3 分与 1.3±1.6 分，p=0.007）的发生率较低。
结论
本研究在大量匹配良好的患者中显示出较高的长期随访率。LSG 术后体重减轻更明显。LAGB 报告了更多的再次手术和对结果的不满。LOS 由并发症患者驱动。这项研究强调了在减重手术中需要综合测量结果。
Zotero 插件