腹腔镜减重代谢手术后患者的远期减重效果及影响因素分析

Long-term weight loss effect and influencing factors of patients after laparoscopic bariatric surgery

目的探讨腹腔镜减重代谢手术后患者远期减重效果及影响因素。方法回顾性分析2020年6月至2021年6月于牡丹江医学院附属红旗医院行腹腔镜减重代谢手术的103例患者临床资料,比较术后3个月(T0)、术后6个月(T1)、术后12个月(T2)患者多余体重下降百分比(%EWL)变化,并参照减重代谢手术效果综合评价系统(BAROS)评分,将T2时评分≤3分的患者纳入A组(n=37),评分>3~9分的患者纳入B组(n=66),采用logistic回归模型分析腹腔镜减重代谢手术后患者远期减重效果的影响因素。结果103例患者T0、T1、T2%EWL整体比较,差异有统计学意义(P<0.05)。两组性别、年龄、婚姻状况、家族遗传肥胖、合并脂肪肝、维生素D缺乏比较,差异无统计学意义(P>0.05);两组患者的基线体重指数(BMI)、腰围、胰岛素抵抗指数(HOMA-IR)、合并睡眠呼吸暂停综合征(OSAHS)比较,差异有统计学意义(P<0.05);logistic回归分析结果显示,基线BMI(β=1.375,OR=3.955,95%CI=1.709~9.151)、腰围(β=0.987,OR=2.683,95%CI=1.146~6.281)、HOMA-IR(β=0.746,OR=2.108,95%CI=1.023~4.345)、合并OSAHS(β=1.038,OR=2.823,95%CI=1.132~7.038)是影响腹腔镜减重代谢手术后患者远期减重效果的独立危险因素(P<0.05)。结论腹腔镜减重代谢手术后远期减重效果显著,而基线BMI、腰围、HOMA-IR、合并OSAHS则是影响腹腔镜减重代谢手术后患者远期减重效果的独立危险因素,临床中需重视具备上述高危因素的患者以确保减重疗效,为临床提供一定参考。

Objective To explore the long-term weight loss effect and influencing factors of patients after laparoscopic bariatric surgery.Methods The clinical data of 103 patients who underwent laparoscopic bariatric surgery in Hongqi Hospital Affiliated to Mudanjiang Medical College from June 2020 to June 2021 were retrospectively analyzed.Changes in the percentage of excess weight loss(%EWL)were compared at 3 months(T0),6 months(T1)and 12 months(T2)after surgery.With reference to bariatric analysis and reporting outcome system(BAROS)score,the patients with score≤3 points at T2 were included in group A(n=37),and the patients with 3 points<BAROS score≤9 points were enrolled as group B(n=66).Logistic regression model was used to analyze the influencing factors of long-term weight loss effect of patients after laparoscopic bariatric surgery.Results A statistical significance was shown by overall comparison of %EWL at T0,T1 and T2 among 103 patients(P<0.05).There were no statistical differences between the groups in terms of gender,age,marital status,familial inheritance of obesity,fatty liver and vitamin D deficiency(P>0.05),but there were statistically significant differences in the baseline body mass index(BMI),waist circumference,homeostasis model assessment of insulin resistance(HOMA-IR)and obstructive sleep apnea-hypopnea syndrome(OSAHS)(P<0.05).Logistic regression analysis revealed that baseline BMI(β=1.375,OR=3.955,95%CI=1.709-9.151),waist circumference(β=0.987,OR=2.683,95%CI=1.146-6.281),HOMA-IR(β=0.746,OR=2.108,95%CI=1.023-4.345)and concomitant OSAHS(β=1.038,OR=2.823,95%CI=1.132-7.038)were independent risk factors for long-term weight loss effect in patients after laparoscopic bariatric surgery(P<0.05).Conclusion The long-term weight loss effect after laparoscopic bariatric surgery is significant,and baseline BMI,waist circumference,HOMA-IR and OSAHS are independent risk factors that affect the long-term weight loss effect of patients after laparoscopic bariatric surgery.In clinical practice,it is necessary to pay attention to patients with the above high-risk factors to ensure the efficacy of weight loss and provide a certain reference for clinical practice.