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减肥手术后的长期随访:系统性审查
Nancy Puzziferri1, Thomas B Roshek2, Helen G Mayo3
1Department of Surgery, University of Texas Southwestern Medical Center, Dallas2Department of Surgery, North Texas Veterans Administration Healthcare System, Dallas.
JAMA
|September 4, 2014
概括
胃绕道手术显示,与胃带相比,2型糖尿病,高血压和高脂血症的长期减肥和缓解率优于胃带. 需要对袖子胃切除术结果进行更多的研究.
科学领域:
- 腹腔外科手术是什么意思
- 肥胖管理 肥胖管理
- 代谢性疾病的治疗 代谢性疾病的治疗
背景情况:
- 腹腔外科手术是对肥胖的公认治疗方法,但具有高保留率的长期随访数据很少.
- 评估不同减肥手术的长期有效性对于临床决策至关重要.
研究的目的:
- 评估腹部外科手术的证据质量和治疗效果在手术后两年.
- 为了比较严重肥胖成年人减肥,2型糖尿病,高血压和高脂血症的结果.
主要方法:
- 对MEDLINE和Cochrane数据库进行了系统审查,搜索了1946年至2014年5月发表的研究.
- 包括的研究重点是胃绕道,胃带或袖子胃切除术,患者的体重指数≥35,超过两年的结果数据和≥80%的患者随访.
- 数据提取和研究纳入是由两个独立研究人员进行的.
主要成果:
- 在7371项研究中,只有29项符合纳入标准,涉及7971名患者.
- 胃绕道和袖子胃切除术在所有分析的研究中都显示了超过50%的体重减轻,而胃带仅在31%的研究中实现了这一点.
- 与胃带 (45.0%) 相比,胃旁路术的体重减轻率 (65.7%) 显著更高. 2型糖尿病,高血压和高脂血症的缓解率在胃绕道后明显高于胃带.
结论:
- 很少有减肥手术研究提供强大的长期随访数据,可能引入偏见.
- 与胃带相比,胃绕道在减肥和并发症缓解方面提供了更好的结果.
- 关于袖子胃切除术的长期疗效的证据仍然不足.
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