胃内球囊术治疗不同体质量指数肥胖症的短期临床疗效

Short term clinical efficacy of intra-gastric balloon on obesity patients with different body mass index

    摘要
  • 摘要:
    目的 探讨胃内球囊术治疗不同体质量指数（BMI）肥胖症的短期临床疗效。
    方法 采用回顾性描述性研究方法。收集2017年1月至2021年12月3家医学中心收治的62例（赫斯特维尔私立医院56例、新南威尔士大学圣乔治私立医院4例、东悉尼私立医院2例）不同BMI肥胖症行胃内球囊术患者的临床资料；男15例,女47例；年龄为45.1（18.0～67.0）岁；BMI为35.1（27.8～48.4）kg/m2。62例患者中,27 kg/m2≤BMI<35 kg/m2 33例,BMI≥35 kg/m2 29例。观察指标：（1）首次手术及术后并发症情况。（2）首次术后随访情况。（3）再次行胃内球囊术及术后并发症情况。（4）再次行胃内球囊术后随访情况。采用门诊方式进行随访。患者于术后1、3、6个月进行随访,了解术后并发症发生情况及减重效果。正态分布的计量资料以x±s表示,偏态分布的计量资料以M（范围）表示。计数资料以绝对数表示。
    结果 （1）首次手术及术后并发症情况。62例肥胖症患者均顺利施行首次胃内球囊术。62例患者中,45例发生术后并发症,包括胃食管反流38例,吞咽困难或打嗝12例,上腹部疼痛9例,恶心呕吐4例,同一例患者可合并多种并发症。33例27 kg/m2≤BMI<35 kg/m2患者和29例BMI≥35 kg/m2患者发生上述并发症分别为21、8、7、2例和17、4、2、2例。（2）首次胃内球囊术后随访情况。62例肥胖症患者中,完成术后1、3、6个月随访分别为52、46、38例,其中27 kg/m2≤BMI<35 kg/m2和BMI≥35 kg/m2分别为30、25、20例和22、21、18例。62例患者中,选择提前取出胃内球囊15例,包括因持续恶心呕吐7例,对短期减重效果不满意6例,急性上腹部疼痛、妊娠各1例。30例27 kg/m2≤BMI<35 kg/m2患者和22例BMI≥35 kg/m2患者术后1个月体质量下降分别为（4.8±3.0）kg和（6.6±2.8）kg；25例27 kg/m2≤BMI<35 kg/m2患者和21例BMI≥35 kg/m2患者术后3个月体质量下降分别为（6.7±4.4）kg和（10.6±4.8）kg；20例27 kg/m2≤BMI<35 kg/m2患者和18例BMI≥35 kg/m2患者术后6个月体质量下降分别为（8.5±4.8）kg和（9.8±3.9）kg,多余体质量减轻百分比分别为53%±26%和29%±15%,总体质量减轻率分别为14%±5%和10%±5%。（3）再次行胃内球囊术及术后并发症情况。完成首次术后6个月随访的38例肥胖症患者中,9例27 kg/m2≤BMI<35 kg/m2和7例BMI≥35 kg/m2患者选择取出首次胃内球囊后立即再次行胃内球囊术,再次手术后发生胃食管反流、吞咽困难或打嗝、上腹部疼痛、恶心呕吐分别为4、3、0、0例和4、0、2、1例。（4）再次行胃内球囊术后随访情况。16例选择再次行胃内球囊术患者均完成术后6个月随访,无患者提前取出胃内球囊。9例27 kg/m2≤BMI<35 kg/m2患者和7例BMI≥35 kg/m2患者术后6个月体质量下降分别为（8.8±8.5）kg和（18.9±9.7）kg,多余体质量减轻百分比分别为44%±38%和41%±15%。
    结论 胃内球囊术应用于BMI≥27 kg/m2肥胖症患者可获得较好短期减重效果,胃食管反流、吞咽困难或打嗝、上腹部疼痛、恶心呕吐是术后常见并发症。

     

    Abstract:
    Objective To investigate the short term clinical efficacy of intra-gastric balloon (IGB) on obesity patients with different body mass index (BMI).
    Methods The retrospective and descriptive study was conducted. The clinical data of 62 obesity patients with different BMI who were admitted to three medical centers, including 56 cases in the Hurstville Private Hospital, 4 cases in the St George Private Hospital of University of New South Wales and 2 cases in the East Sydney Private Hospital, from January 2017 to December 2021 were collected. There were 15 males and 47 females, aged 45.1(range, 18.0 to 67.0)years, with the BMI of 35.1(range, 27.8 to 48.4)kg/m2. Of the 62 patients, there were 33 cases with 27 kg/m2≤BMI<35 kg/m2 and 29 cases with BMI≥35 kg/m2. Observation indicators: (1) first operation and postoperative complications; (2) follow-up after first IGB; (3) recurrent IGB and postoperative complications; (4) follow up after recurrent IGB. Follow-up was conducted using outpatient examinations to detect postoperative complications and weight loss effects. Patients were followed up at postoperative 1, 3, 6 month. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers.
    Results (1) First opera-tion and postoperative complications. All 62 obesity patients underwent the first IGB successfully. Of the 62 patients, 45 cases had postoperative complications, including 38 cases with gastroesophageal reflux, 12 cases with dysphagia or burping, 9 cases with epigastric pain and 4 cases with nausea. One patient may have multiple complications. Cases with above complications in the 33 cases with 27 kg/m2≤BMI<35 kg/m2 and 29 cases with BMI≥35 kg/m2 were 21, 8, 7, 2 and 17, 4, 2, 2, respectively. (2) Follow-up after first IGB. Of the 62 obesity patients, there were 52, 46 and 38 cases completing followed up at postoperative 1, 3 and 6 month, respectively, including 30, 25,20 cases in patients with 27 kg/m2≤BMI<35 kg/m2 and 22, 21, 18 cases in patients with BMI≥35 kg/m2. Of the 62 obesity patients, there were 15 cases requiring early balloon extraction due to intractable symptoms, inclu-ding 7 cases with ongoing dysphagia or burping, 6 cases with complaining of ineffective weight loss, 1 case with acute right-sided abdominal pain and 1 case with a serendipitous discovery of pregnant. The cumulative weight loss of the 30 cases with 27 kg/m2≤BMI<35 kg/m2 and 22 cases with BMI≥35 kg/m2 at postoperative 1 month was (4.8±3.0)kg and (6.6±2.8)kg, respectively. The above indicator was (6.7±4.4)kg and (10.6±4.8)kg at postoperative 3 month for the 25 cases with 27 kg/m2≤BMI<35 kg/m2 and 21 cases with BMI≥35 kg/m2, and (8.5±4.8)kg and (9.8±3.9)kg at postoperative 6 month for the 20 cases with 27 kg/m2≤BMI<35 kg/m2 and 18 cases with BMI≥35 kg/m2. The percentage of excess weight loss was 53%±26% and 29%±15% at postoperative 6 month and the percentage of total weight loss was 14%±5% and 10%±5% at postoperative 6 month for the 20 cases with 27 kg/m2≤BMI<35 kg/m2 and 18 cases with BMI≥35 kg/m2, respectively. (3) Recurrent IGB and postoperative complications. Of the 38 cases completing the postoperative 6 month followed up after the first IGB, 9 cases with 27 kg/m2≤BMI<35 kg/m2 and 7 cases with BMI≥35 kg/m2 choosing a second IGB immediately after the removal of the first balloon. Cases with postoperative compli-cations, including gastroesophageal reflux, dysphagia or burping, epigastric pain, nausea were 4, 3, 0, 0 in patients with 27 kg/m2≤BMI<35 kg/m2 and 4, 0, 2, 1 in patients with BMI≥35 kg/m2. (4) Follow up after recurrent IGB. All the 16 patients who chosen a second IGB completed the postoperative 6 month followed up, with the cumulative weight loss of (8.8±8.5)kg and (18.9±9.7)kg and the percentage of excess weight loss of 44%±38% and 41%±15% in the 9 cases with 27 kg/m2≤BMI<35 kg/m2 and 7 cases with BMI≥35 kg/m2, respectively.
    Conclusions IGB can achieve a good short-term weight loss effects in obesity patients with BMI≥27 kg/m2. Gastroesophageal reflux, dysphagia or burping, epigastric pain and nausea are common postoperative complications.

     

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