减重代谢手术效果评价系统的应用

doi:10.16139/j.1007-9610.2020.05.010

摘要/Abstract

摘要：

目的： 应用减重代谢手术效果评价系统（bariatric analysis and reporting outcome system,BAROS）评价肥胖病人减重代谢手术的效果。方法： 入组105例减重代谢术肥胖病人。按术后随访时间分为4组,分别为术后3~12个月（40例）、13~36个月（38例）、37~60个月（16例）和>61个月（11例）。采用中文版本BAROS,分析病人术后的多余体重下降率（percentage of excess weight loss, %EWL）、肥胖相关合并症改善、生活质量及术后并发症和再手术,评价病人手术效果。结果： 所有病人均完成BAROS评价,随访（26.26±25.51）（3~114）个月。与术前相比,各组术后体质量指数均明显降低（P值均<0.001）。各组%EWL依次为57.3%±17.6%、83.5%±11.4%、84.9%±8.2%和88.2%±8.9%（P<0.001）。肥胖相关合并症在术后都得到较好改善,其中2型糖尿病缓解率69.77%,高脂血症缓解率98.15%。生活质量平均得分1.59±0.49。生活质量评定为“好”和“非常好”的病人为86.70%,无评价为“差”和“非常差”的病人,各组之间生活质量评价构成比差异无统计学意义（ χ²=7.506,P=0.277）。共18例出现并发症,1例再手术。BAROS评价结果显示手术效果评定为“极好”和“很好”为89.6%,无评价为“失败”的病人,各组间效果评价构成比差异无统计学意义（ χ²=6.682,P=0.670）。结论： BAROS可用于肥胖病人减重代谢手术的效果评价,术后短期与中、长期的病人均达到较好的评价效果。

关键词: 肥胖, 减重代谢手术, 手术效果评价

Abstract:

Objective To use the Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire and to evaluate the effect of bariatric and metabolic surgery (BMS) on obese patients. Methods A total of 105 patients with BMS were enrolled and stratified into 4 groups according to postoperative duration: 3-12 months (n=40), 13-36 months (n=38), 37-60 months (n=16) and >61 months (n=11). The Chinese version of BAROS was used to evaluate the results of operation including percentage of excess weight loss (%EWL), improvement of co-morbidities associated with obesity, quality of life (QOL), postoperative complications and reoperation. Results All patients completed BAROS questionnaire and were followed-up with duration of (26.26±25.51) (3-114) months. Postoperative body mass index decreased significantly compared with those preoperative in all groups (P<0.001). %EWL of patients in group 3-12 months was 57.3%±17.6%, and 83.5%±11.4% in group 13-36 months, 84.9%±8.2% in group 37-60 months and 88.2%±8.9% in group >61 months (P<0.001). The co-morbidities with obese improved significantly and remission rate was 69.77% in cases with type 2 diabetes, 98.15% in cases with hyperlipidemia. Mean score of QOL was (1.59±0.49). QOL was evaluated good and very good in 86.70% cases without any case evaluated as poor or very poor. Difference in QOL(%) among all groups was not statistically significant( χ²=7.506, P=0.277). There were 18 cases with complications and one case had reoperation. Evaluation of operative results using BAROS score showed 89.6% cases as excellent and good and no case as failure of operation. There was no statistically significant difference among groups ( χ²=6.682, P=0.670). Conclusions BAROS can be used to analyze the effect of BMS and the results of short-term and middle/long term in this study were encouraged.

Key words: Obesity, Bariatric and metabolic surgery, Evaluation of operative effect

中图分类号:

R589.2

廉东波, 刘晨, 闫巍, 杜德晓, 宫轲, 张能维. 减重代谢手术效果评价系统的应用[J]. 外科理论与实践, 2020, 25(05): 402-407.

LIAN Dongbo, LIU Chen, YAN Wei, DU Dexiao, GONG Ke, ZHANG Nengwei. Application of bariatric and metabolic analysis and reporting outcome system[J]. Journal of Surgery Concepts & Practice, 2020, 25(05): 402-407.

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参考文献 21

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分组	n	年龄（岁）	术前BMI
1	40	29.53±7.31	39.71±6.41
2	38	31.47±8.27	39.58±5.26
3	16	33.69±9.07	37.17±5.43
4	11	34.18±3.92	36.06±2.60
F值		1.735	1.935
P值		0.165	0.129

减重效果（得分）	合并症（得分）	Moorehead-Ardelt生活质量问卷（得分）^a)
体重增加（-1） %EWL	加重（-1）	1. 通常我觉得：自己糟透了自己棒极了 2. 我对身体活动的享受程度：一点不喜欢非常喜欢 3. 我参加令人满意的社交活动：没有非常多 4. 我能完成工作：不能完成任何工作非常多工作 5. 我从性生活得到满足感：完全没有极大满足 6. 我对吃的看法是：为吃而生活为生活而吃
0-24（0）	无变化（0）
25-49（1）	改善（1）
50-74（2）	1个主要合并症缓解,其余改善（2）
75-100（3）	所有主要合并症缓解（3）
小计（得分）	小计（得分）	小计（得分）
术后并发症和再手术（扣分）轻度并发症：扣0.2分严重并发症：扣1.0分再手术：扣1分		效果评价标准^b)
术后并发症和再手术（扣分）轻度并发症：扣0.2分严重并发症：扣1.0分再手术：扣1分		效果有肥胖相关合并症无肥胖相关合并症失败得分≤1 得分=0 一般 1<得分≤3 0<得分≤1.5 良好 3<得分≤5 1.5<得分≤3.0 很好 5<得分≤7 3.0<得分≤4.5 极好 7<得分≤9 4.5<得分≤6.0

疾病	诊断标准	缓解标准	改善标准
高血压	收缩压>130 mmHg,舒张压>80 mmHg	仅饮食/利尿药可保持血压正常	服用药物可控制血压
心血管疾病	有冠心病、周围血管疾病或充血心力衰竭证据	不需服用药物即可控制	需服用药物控制
血脂异常	总胆固醇>6.0 mmol/L,或其他脂类代谢异常	不需服用药物即可控制	服用药物可正常
2型糖尿病	有症状+餐后血糖>11.1 mmol/L,或空腹血糖>7.0 mmol/L,或糖耐量实验2 h血糖>11 mmol/L	仅饮食控制/锻炼可保持正常	口服降糖药可正常（不需胰岛素）
睡眠呼吸暂停综合征	睡眠监测诊断,二氧化碳分压>45 mmHg,血红蛋白>150 g/L	正常（呼吸暂停<5次/h）	呼吸暂停5~15次/h
骨关节炎	影像学检查评估	不需服用药物即可控制	服用药物可控制
不育症(多囊卵巢）	不育/性激素异常	怀孕	月经正常

	外科并发症		内科并发症
	严重	轻度	严重	轻度
早期	胃肠道漏伴腹膜炎或腹腔脓肿	血清肿	肺炎,严重肺不张	肺不张,尿路感染
	严重切口感染,切口裂开	轻微切口感染	呼吸功能不全,肺水肿	深静脉血栓形成
	腹腔出血,胃肠道出血需输血脾损伤需脾切除术	皮下气肿	肺栓塞,急性呼吸功能障碍综合征	电解质失衡,呕吐
	其他严重器官损伤,严重肠梗阻		心肌梗死,充血性心力衰竭	食管炎
	肠扭转/闭襻肠梗阻		脑血管意外
			急性肾功能衰竭
			严重术后抑郁
			其他精神异常
晚期	复杂消化性溃疡病	吻合口狭窄,电解质失衡	肝衰竭,肝硬化	贫血
	胆石病,切口疝	持续恶心或呕吐	神经性厌食症,暴食症	代谢缺陷（维生素/
	胃漏	食管炎,Barrett食管	严重抑郁	矿物质/蛋白质缺乏）
	严重蛋白质缺乏或其他营养问题需住院治疗	吻合口溃疡,消化性溃疡		脱发

分组	例数	术前BMI	术后BMI	t值	P值
1	40	39.71±6.41	30.88±5.56	13.415	<0.001
2	38	39.58±5.26	26.45±3.38	17.085	<0.001
3	16	37.17±5.43	25.23±1.83	11.515	<0.001
4	11	36.06±2.60	24.02±1.02	13.071	<0.001