在胃短路术后，小胃袋的大小与体重下降至关重要

   2006年5月2日，达拉斯（美国得克萨斯州东北部城市）－－－在经腹腔镜行Roux-en-Y胃肠短路术的体重下降的量与术后所残存胃袋的大小呈反相关。残胃袋的体积由几个特定的因素决定。这个研究结果是由耶鲁大学医学院的Kurt E. Roberts, MD,最新发布的。

  他说：“在我们的研究中发现患者的术后的体重丢失多发术后6～12个月，其中，残胃的大小至关重要。”

  研究的对象包括320个经腹腔镜行Roux-en-Y胃肠短路术的患者。全部病例由2个外科医生实施了这些手术，患者的平均年龄为41岁，其中女性为262人（81.6％）。患者的术前的体重指数（BMI）为51.1（36.1～89.9）kg/m²

 在术后的第1年，可由前－后位的放射成像来计算胃袋区的大小（测其长、宽和假定深度衡定）

此法并不是直接的测量胃袋的容积。研究者使用一些方法来调整数据以确保此结果可靠且易于实施。

患者的平均胃袋容积为63.91（8～248）cm² ，使用多因素的线性回归分析研究发现，6月后患者的胃袋小于60cm²的体重丢失原超重的55％；而胃袋大于120cm²的体重丢失仅有原超重部分的40％。

However, Dr. Roberts 重申：我们的统计数据显示胃袋的大小或容积是体重丢失的显著的预后因素。

此研究的来源显示：资助基金独立的，作者无相关的财务污点。

原文：SAGES 2006: Abstract S029. Presented April 29, 2006.

       May 2, 2006 (Dallas) — There is an inverse relationship between gastric pouch size and weight loss after laparoscopic Roux-en-Y gastric bypass surgery, but certain cofactors affect gastric pouch size, a new study reveals. Kurt E. Roberts, MD, from Yale University School of Medicine in New Haven, Connecticut, presented these findings here at the Society of Gastrointestinal and Endoscopic Surgeons 2006 Annual Meeting.

"Size matters," Dr. Roberts told Medscape. "Our study found that patients with smaller pouches lost the most weight at 6- and 12-month follow-ups."

The study by Dr. Roberts and colleagues involved 320 patients who underwent laparoscopic Roux-en-Y gastric bypass surgery at Yale School of Medicine. Two surgeons performed the procedures. The mean age of participants was 41 years, and 262 were women (81.6%). Patients had a mean preoperative body mass index (BMI) of 51.1 kg/m² with a range of 36.1 to 89.9 kg/m².

At postoperative day 1, the researchers measured pouch size by performing an upper gastrointestinal series on 216 of the patients. From anterior-posterior radiographs, they calculated gastric pouch area by measuring length and width of the maximally distended gastric pouch. They assumed depth of the gastric pouch to be constant.

Although this method does not directly measure gastric pouch volume, Dr. Roberts told Medscape that he and his colleagues used a modification of techniques validated in previous studies and that their measurement technique is "reliable and easy to reproduce."

Patients had a mean gastric pouch size of 63.91 cm² with a range of 8 to 248 cm². Using a multiple linear regression analysis, the researchers found that at 6 months patients with gastric pouches smaller than 60 cm2 lost about 55% of their excess weight, as opposed to patients whose gastric pouches were greater than 120 cm2, who lost only about 40% of their excess weight (P < .001).

At 12 months, the difference was even more apparent. Patients with gastric pouches smaller than 60 cm2 had lost an average of 69.2% of their excess weight. Those with gastric pouches measuring 90 to 120 cm2 lost about 53% of excess weight, and patients with pouches greater than 120 cm2 had lost only about 48% of excess weight (P < .001).

"Our study demonstrates that patients with smaller pouch size lost more weight over time," Dr. Roberts said. "But one unique aspect of our study is that we also looked at cofactors that might affect pouch size." These included age, sex, and preoperative BMI.

They found that patients with preoperative BMIs higher than 50 had larger pouches, averaging about 74 cm2. In addition, male sex also correlated with larger pouch size. Male patients had a mean pouch size of 79 cm2 while pouch size in women averaged about 61 cm2. "Male gender and higher preoperative BMI subsequently influenced excess weight loss after gastric bypass surgery," he told Medscape.

"Age was not a statistically significant factor in larger pouch size," Dr. Roberts pointed out during his presentation.

Ricardo Cohen, MD, the moderator for session at which the research was presented, commented to Medscape on Dr. Roberts' findings. "The theory today about why gastric bypass leads to weight loss depends more on endocrine changes — such as a decrease in ghrelin — than pouch size," he said. "Gastric pouch size matters to launch the weight loss, but not to maintain it." Dr. Cohen is the director of the Center for the Surgical Treatment of Morbid Obesity at São Camilo Hospital in São Paulo, Brazil. He was not involved in the study.

Dr. Cohen also commented that it is impossible to precisely measure gastric pouch size and volume. "What may actually matter more than size is gastric pouch emptying," he said.

However, Dr. Roberts reiterated to Medscape, "Our statistical analysis showed that pouch size area is a significant predictor of weight loss."

This study was independently funded. The authors report no pertinent financial disclosures.

SAGES 2006: Abstract S029. Presented April 29, 2006.

Reviewed by Carol Peckham

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