治療病態肥胖的新希望

青少年實行肥胖手術如果放置胃內氣囊可能就不需要手術

  2002年5月23日─在5月20日以及22日,在DDW年會上提出的兩種新的治療病態肥胖的方法,為控制這種萌芽中的疾病的流行,提供了新的希望。一項研究顯示,肥胖手術應用於青少年與應用於成人同樣有效,另外一項研究顯示,胃內氣囊可以有助於改善結局,或者使藥物治療以及諮詢無效的患者,不需要手術。

  佛吉尼亞州的Harvey J. Sugerman及其同事寫道:「嚴重肥胖在青少年中迅速增長,引起明顯的總發病率以及社會病態人群的增加。」

  32位符合NIH20歲以上年齡層肥胖手術標準的青少年,有三人進行了gastroplasty手術,16人進行了gastric bypass手術,3人進行了distal gastric bypass,10人進行了long-limb gastric bypass手術。沒有出現手術後的死亡或者滲漏。早期併發症包括一例肺栓塞,1例嚴重傷口感染以及4例輕度傷口感染,另有3例胃部狹窄在內窺鏡下加以擴張,4例邊緣性潰瘍進行了抗酸治療。後期的併發症包括1例腸梗阻,4例切口疝,以及手後6年的1例猝死。有兩位原患者需要再次進行手術,1位是因為營養不良,另外1位是因為體重減輕的不夠。

  術後1年時,除了2例高血壓,2例GERD以及7例退行性關節病外,大多數的各種疾病都得到了解決。患者的自我形象改善,使8位患者結了婚,5位患者大學畢業,目前還有兩位患者正在讀大學。

   「對青少年實行肥胖手術很安全,可以引起明顯的體重降低,肥胖引起的各種疾病的改善以及提高患者的自我形象與社會化,」作者寫道:「這些資料強有力的支援,我們應該對這些需要改善的病患進行手術。而且根據1991年NIH意見研討會的結果,他們很難得到醫療保險。」

  另外一項研究中,土耳其伊斯坦布爾的Feryal Ilkova及其同事,對17位年齡在20至67歲的患者,進行了內窺鏡下胃內氣囊植入(BioEnterics, BIB, USA)。其中兩位患者在第三個月時,體重就降低到可以取出氣囊的程度,其他的患者在6個月時取出了氣囊。沒有明顯的併發症。平均體重指數在氣囊植入前是42.3,氣囊取出後則為33.81(P< .0001)。

   「胃內氣囊是一種治療病態肥胖的安全有效的方法,」作者寫道:「可以在那些飲食治療以及藥物治療無效的患者手術前,向他們推薦。」

New Hope for Morbid Obesity

Bariatric Surgery Safe in Adolescents; Intragastric Balloon May Obviate Surgery

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

May 23, 2002 --Two approaches to morbid obesity presented on May 20 and May 22 at the DDW annual meeting offer new hope of limiting this burgeoning epidemic. One study suggests that bariatric surgery is as safe in adolescents as it is in adults. The other indicates that an intragastric balloon may help improve outcome or obviate the need for surgery in patients failing medication and counseling.

"Severe obesity is increasing rapidly in adolescents and is associated with significant comorbidity and social stigmatization," write Harvey J. Sugerman and colleagues from Richmond, Virginia.

Of 32 adolescents meeting NIH adult criteria for bariatric surgery over a 20-year period, 3 had gastroplasty, 16 had gastric bypass, 3 had distal gastric bypass, and 10 had long-limb gastric bypass. There were no postoperative deaths or leaks. Early complications included 1 pulmonary embolus, 1 major wound infection, 4 minor wound problems, 3 stomal stenoses that were dilated endoscopically, and 4 marginal ulcers treated with acid suppression. Late complications included 1 bowel obstruction, 4 incisional hernias, and 1 sudden death 6 years after surgery. Two patients needed revisional surgery, 1 for malnutrition, and 1 for inadequate weight loss.

At 1 year, most comorbidities resolved except for 2 cases of hypertension, 2 of GERD, and 7 of degenerative joint disease. Improved self-image facilitated marriage in 8 patients, college graduation in 5 and current college attendance in 2.

"Bariatric surgery in adolescents is safe and associated with significant weight loss, correction of obesity comorbidity as well as improved self-image and socialization," the authors write. "These data strongly support surgery for these unfortunate individuals in whom it may be difficult to obtain insurance coverage based upon the 1991 NIH Consensus Conference Statement."

In a separate study by Feryal Ilkova and colleagues from Istanbul, Turkey, 17 patients, aged 20 to 67, had endoscopic insertion of an intragastric balloon (BioEnterics, BIB, USA). In 2 patients, weight loss was sufficient to allow balloon removal at 3 months, and the remaining patients had the balloon removed at 6 months. There were no apparent complications. Mean body mass index decreased from 42.3 before balloon insertion to 33.81 after balloon removal (P< .0001).

"The intragastric balloon is a safe and effective noninvasive method in the treatment of morbid obesity," the authors write. "It can be suggested to the patients unresponsive to diet and medical therapy before surgery."

© 2002 WebMD Inc. All rights reserved.

    
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