腹腔镜Roux-en-Y胃旁路术与腹腔镜袖状胃切除术对改善肥胖患者血脂的Meta分析

Effect of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on serum lipid improvement in obese patients:a meta-analysis

目的:比较腹腔镜Roux-en-Y胃旁路术(LRYGB)与腹腔镜袖状胃切除术(LSG)对肥胖症的减重效果及对血脂的影响。方法:检索相关数据库,以获取比较LRYGB与LSG治疗肥胖患者及改善血脂的相关中、英文文献,检索时间自建库至2022年9月,对纳入文献进行质量评价、提取数据及数据统计分析。结果:共纳入15篇文献,其中LRYGB组4033例,LSG组4859例。与LSG组相比,LRYGB组术后甘油三酯水平较低[MD=-0.19,95%CI(-0.33,-0.04),P<0.05],总胆固醇水平较低[MD=-0.61,95%CI(-0.95,-0.28),P<0.05],低密度脂蛋白水平较低[MD=-0.54,95%CI(-0.85,-0.24),P<0.05];两组术后体质指数[MD=-0.10,95%CI(-0.23,0.02),P>0.05]、高密度脂蛋白[MD=-0.12,95%CI(-0.40,0.15),P>0.05]、血脂异常缓解率[RR=1.14,95%CI(0.99,1.30),P>0.05]差异无统计学意义。结论:LRYGB与LSG治疗肥胖症均是有效术式。与LSG相比,LRYGB能显著改善血脂,且甘油三酯、总胆固醇、低密度脂蛋白的降低效果更好,但两种术式在肥胖患者血脂异常缓解率方面效果相近。

Objective:To compare the effect of laparoscopic Roux-en-Y gastric bypass(LRYGB)and laparoscopic sleeve gastrectomy(LSG)on weight loss and serum lipid in obese patients.Methods:Relevant literatures were retrieved from the establishment of the database to Sep.2022,including the Chinese and English literatures related to the comparison of LRYGB and LSG in the treatment of obesity patients and the improvement of serum lipids.Quality evaluation,data extraction and statistical analysis were carried out for the included literatures.Results:A total of 15 literatures were included,there were 4033 cases in LRYGB group and 4859 cases in LSG group.Meta-analysis showed that compared with LSG group,LRYGB group had lower triglyceride level[MD=-0.19,95%CI(-0.33,-0.04),P<0.05],lower total cholesterol level[MD=-0.61,95%CI(-0.95,-0.28),P<0.05]and lower low-density lipoprotein[MD=-0.54,95%CI(-0.85,-0.24),P<0.05]after operation.There were no significant differences in postoperative body mass index[MD=-0.10,95%CI(-0.23,0.02),P>0.05],high-density lipoprotein[MD=-0.12,95%CI(-0.40,0.15),P>0.05]and remission rate of dyslipidemia[RR=1.14,95%CI(0.99,1.30),P>0.05].Conclusions:LRYGB and LSG are effective methods for treating obesity.Compared with LSG,LRYGB can significantly improve serum lipids and lower triglycerides,total cholesterol and low-density lipoprotein,but there is no significant difference in the remission rate of dyslipidemia between the two operations.