三种减重代谢手术后妊娠结局及妊娠期并发症

doi:10.16139/j.1007-9610.2020.05.011

摘要/Abstract

摘要：

目的： 比较三种减重代谢手术后妊娠结局,探索减重代谢手术后围产期的管理措施。方法： 回顾性分析2014年1月至2019年12月在我院接受减重代谢手术后的生育状况。统计袖状胃切除术（sleeve gastrectomy, SG）、胃旁路术（Roux-en-Y gastric bypass, RYGB）和袖状胃切除加空肠旷置术（sleeve gastrectomy+jejunojejunal bypass, SG+JJB）术后孕妇的减重以及营养状况、妊娠以及围产期母婴状况,包括产妇的体质量指数（body mass index,BMI）、新生儿体重、新生儿并发症和孕前及产前孕妇的营养状况等。结果： 46例术后分娩新生儿48例。RYGB组16例,SG组16例,SG+JJB组14例。1例生育2胎,1例双胎妊娠。46例术前BMI 40.92±6.93,术前体重(111.29±18.10) kg。术前合并多囊卵巢综合征36例（78.26%）。孕前体重(74.19±12.62) kg,产前体重(83.61±11.89) kg,产后1个月体重(76.56±11.39) kg。新生儿体重(3.12±0.54) kg。孕前RYGB组孕妇贫血6例,新生儿低体重3例。SG+JJB组新生儿贫血1例,新生儿低体重1例。结论： 三种减重代谢手术术后妊娠均安全。减少吸收的术式需更多关注营养状况,特别是RYGB需加强围产期的指导。

关键词: 减重代谢手术, 妊娠, 并发症, 围产期管理

Abstract:

Objective To compare the pregnant outcomes of three types of bariatric and metabolic surgery (BMS) and explore the management measures during the perinatal period after BMS. Methods A retrospective analysis was conducted for the fertility in the patients underwent BMS in our hospital from January 2014 to December 2019. The weight loss and nutritional status of women with pregnancy, results of both pregnancy and perinatal maternal and infant were analysed after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or SG plus jejunojejunal bypass (SG+JJB) including maternal body mass index (BMI), newborn weight, neonatal complications and nutritional status of both pre-pregnancy and pregnant women before delivery. Results A total of 46 patients who underwent BMS including 16 cases in RYGB, 16 cases in SG, and 14 cases in SG+JJB delivered 48 newborns. Both twins and two babies delivered in one patient each. Mean BMI and mean weight preoperative were 40.92±6.93 and (111.29±18.10) kg in 46 patients, respectively. Thirty-six patients (78.26%) had polycystic ovary syndrome preoperatively. Mean weight was (74.19±12.62) kg before pregnancy and (83.61±11.89) kg before childbirth, and (76.56±11.39) kg after child birth one month later. Mean weight of newborns was (3.12±0.54) kg. There were 6 pregnancy case with anemia and 3 newborn with low birth weight in RYGB group. One newborn with anemia and one newborn with low birth weight were detected in SG+JJB group. Conclusions Pregnancy would be safe after the three types of BMS. Attentions should be paid on the nutritional status with perinatal guidance after surgery of malabsorption, especially RYGB.

Key words: Bariatric and metabolic surgery, Pregnancy, Complications, Perinatal management

中图分类号:

R589.2

刘瑞萍, 杨宁琍, 林士波, 管蔚, 梁辉. 三种减重代谢手术后妊娠结局及妊娠期并发症[J]. 外科理论与实践, 2020, 25(05): 408-412.

LIU Ruiping, YANG Ningli, LIN Shibo, GUAN Wei, Liang Hui. Pregnancy outcomes and perinatal complications after three types of bariatric and metabolic surgery[J]. Journal of Surgery Concepts & Practice, 2020, 25(05): 408-412.

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