腹腔镜胃袖状切除术术后10年及以上结果的Meta分析

Long-term outcomes(10 or more years)of laparoscopic sleeve gastrectomy:a meta-analysis

目的系统评价腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)术后10年及以上的结果。方法计算机检索Web of Science、PubMed、Embase、The Cochrane Library数据库中关于LSG术后10年及以上研究报告,提取文献的相关数据,并对其进行系统评价和Meta分析。结果共纳入10篇文献、954例病人。Meta分析结果显示,LSG术后,体重指数(body mass index,BMI)平均下降了11.49 kg/m^(2)[95%CI(9.97,13.01)],合并的总体重减少百分比(percentage of total weight loss,%TWL)为28.2%[95%CI(23.2%,33.2%)];多余体重减少百分比(percentage of excess weight loss,%EWL)为53.5%[95%CI(46.6%,60.4%)]。LSG术后10年及以上修正手术总体发生率为24.6%[95%CI(13.4%,35.7%)],主要原因:减重失败占20.7%[95%CI(15.1%,26.3%)],胃食管反流病(gastroesophageal reflux disease,GERD)占6.0%[95%CI(2.2%,9.7%)]。高血压缓解率为36.1%[95%CI(20.0%,52.3%)];糖尿病缓解率为41.3%[95%CI(21.3%,61.3%)]。新发GERD发生率为41.6%[95%CI(24.6%,58.7%)]。结论LSG可明显降低体重、有效缓解高血压和糖尿病,但LSG术后长期的修正手术发生率及新发GERD发生率高,修正手术的主要原因是减重失败和GERD。

Objective To evaluate the long-term outcomes(10 or more years))after laparoscopic sleeve gastrectomy(LSG).Methods The databases of Web of Science,PubMed,Embase,Cochrane Library and Clinical Trials.gov were searched for all studies reporting 10 or more years after LSG.And the relevant literature items were extracted and meta analysis was performed.Results Ten studies involving a total of 954 patients fulfilled the inclusion criteria.Meta-analysis revealed that LSG was associated with a significant reduction in body mass index(MD=11.49 kg/m^(2),95%CI(9.97,13.01),pooled percentage of total weight loss(%TWL)was 28.2%[95%CI(23.2%,33.2%)]and pooled of percentage of excess weight loss(%EWL)53.5%[95%CI(46.6%,60.4%)].At 10 or more years post-LSG,the overall revision rate was estimated at 24.6%[95%CI(13.4%,35.7%)],major reason for revision was failure in weight loss 20.7%[95%CI(15.1%,26.3%)]and gastroesophageal reflux disease(GERD)6.0%[95%CI(2.2%,9.7%)].The incidence of hypertension remission post-LSG was 36.1%[95%CI(20.0%,52.3%)],diabetes mellitus 41.3%[95%CI(21.3%,61.3%)]and denovo GERD 41.6%[95%CI(24.6%,58.7%)].Conclusion LSG can significantly reduce weight and effectively relieve hypertension and diabetes.However,the incidence of revisional surgery and de novo GERD are still high during long-term follow-up post-LSG.The major reasons for revisional surgery are failure in weight loss and GERD.