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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2021, Vol. 07 ›› Issue (03) : 175 -185. doi: 10.3877/cma.j.issn.2095-9605.2021.03.007

循证医学

术前减重在减重代谢手术中的作用：一项系统评价及Meta分析
罗奎1, 罗衡桂1,†(), 唐彬1, 毛岳峰1, 王力1, 张晓玲1, 陈伟1, 陈香林1, 姜媛媛1   
  1. 1. 411100　湘潭，湖南省湘潭市中心医院减重代谢外科中心
  • 收稿日期:2021-01-21 出版日期:2021-08-30
  • 通信作者: 罗衡桂

Role of preoperative weight loss in weight-loss metabolic surgery: a systematic review and Meta-analysis

Kui Luo1, Henggui Luo1,†(), Bing Tang1, Yuefeng Mao1, Li Wang1, Xiaoling Zhang1, Wei Chen1, Xianglin Chen1, Yuanyuan Jiang1   

  1. 1. Bariatric and Metabolic Surgery Center, Xiangtan Central Hospital, Xiangtang 411100, China
  • Received:2021-01-21 Published:2021-08-30
  • Corresponding author: Henggui Luo
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引用本文：

罗奎, 罗衡桂, 唐彬, 毛岳峰, 王力, 张晓玲, 陈伟, 陈香林, 姜媛媛. 术前减重在减重代谢手术中的作用：一项系统评价及Meta分析[J]. 中华肥胖与代谢病电子杂志, 2021, 07(03): 175-185.

Kui Luo, Henggui Luo, Bing Tang, Yuefeng Mao, Li Wang, Xiaoling Zhang, Wei Chen, Xianglin Chen, Yuanyuan Jiang. Role of preoperative weight loss in weight-loss metabolic surgery: a systematic review and Meta-analysis[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(03): 175-185.

目的

系统评价术前减重是否可以改善减重代谢手术患者的临床疗效。

方法

通过检索PubMed、Emabase、Cochrane数据库搜集关于术前减重对接受减重代谢手术治疗患者临床疗效的研究，检索时限均从建库至2020年10月。采用Review Manager 5.3软件进行Meta分析，主要评估术前合并症改善、术中腔镜中转、手术时间、住院时间、非计划二次手术、术后伤口感染、术后出血、术后早期并发症、术后合并症改善、术后体重减轻指标。

结果

共纳入包括6 000名患者在内的10项研究。Meta分析显示，与常规对照组相比，术前减重组在术前合并症改善、术中腔镜中转、手术时间、术后早期并发症、术后出血、术后伤口感染、非计划二次手术、住院时间、术后合并症改善、术后6个月减轻指标、术后12个月均无明显获益，两组间差异均无统计学意义。而术前减重组在术后短期3个月内体重减轻更明显。

结论

实施减重代谢手术前进行术前减重可能使患者在术后短期内体重减轻更明显，但在围手术期风险、合并症改善、住院时间、远期体重减轻等方面获益并不明显，其临床疗效仍需更多高级别循证研究证据的帮助与支持。

关键词: 术前减重, 减重代谢手术, Meta分析, 系统评价
Objective

To evaluate systematically whether Preoperative weight loss can improve the clinical efficacy of patients undergoing bariatric surgery.

Methods

The study was collected by searching the database of PubMed, Emabase and Cochrane. The retrieval time was from inception of the database to October 2020. Meta-analysis was performed with Review Manager 5.3. The improvement of preoperative complications, conversion to endoscopy, operation time, hospital stay, unplanned secondary operation, postoperative wound infection, postoperative bleeding, early postoperative complications, improvement of postoperative complications and postoperative weight loss were evaluated.

Results

A total of 10 studies were finally included involving 6000 patients. Meta-analysis showed that, compared with the routine control group, reduced weight before operation group had no benefit in preoperative complications improvement, intraoperative endoscopic conversion, operation time, early postoperative complications, and postoperative bleeding, postoperative wound infection, unplanned second operation, hospital stay, postoperative complications improvement, weight loss index after 6 months, weight loss index after 12 months. There was no significant difference between the two groups. But, the weight loss before operation was more obvious within 3 months after operation.

Conclusions

Preoperative weight loss before bariatric surgery may make patients lose weight more obviously in the short term after operation, but they cannot benefit from perioperative risk, improvement of complications, hospital stay, and long-term weight loss and so on. Its clinical effect still needs the help and support of more high-level evidence-based research evidence.

Key words: Preoperative weight loss, Bariatric surgery, Meta-analysis, Systematic review
表1 纳入研究的基本特征
纳入研究 研究类型 例数（减重组/对照组） 结局指标
Monfared S, 2020 队列研究 502/274 ①⑧⑨
Chinaka U,2019 队列研究 122/33 ⑨⑩
Stefura T,2019 队列研究 349/560 ①②③④⑤⑥⑦⑧⑩
Tan SYT,2020 队列研究 225/59 ③④⑧⑩
Hutcheon DA,2018 队列研究 49/52 ①③④⑦⑧⑩
Riess KP,2008 队列研究 56/441 ①②③④⑤⑦⑧⑩
Alami RS,2007 随机对照 10/10 ①③④⑤⑦⑧⑩
Harnisch MC,2008 队列研究 39/267 ①②③④⑤⑥⑦⑨⑩
Huerta S,2008 队列研究 224/131 ①③④⑧⑩
Fujioka K,2008 队列研究 266/88 ⑤⑥
图1 文献筛选流程及结果
表2 纳入研究的基本特征
纳入研究 减重方式 分组方式
Monfared S, 2020 体重管理 减重组参加，未达到预定目标则纳入对照组
Chinaka U,2019 体重管理 全员参加，达到预定目标则纳入减重组
Stefura T,2019 体重管理 全员参加，达到预定目标则纳入减重组
Tan SYT,2020 低热量饮食 全员参加，达到预定目标则纳入减重组
Hutcheon DA,2018 低热量饮食 全员参加，达到预定目标则纳入减重组
Riess KP,2008 体重管理 减重组参加，未达到预定目标则纳入对照组
Alami RS,2007 体重管理 减重组参加，未达到预定目标则纳入对照组
Harnisch MC,2008 体重管理 全员参加，达到预定目标则纳入减重组
Huerta S,2008 体重管理 全员参加，达到预定目标则纳入减重组
Fujioka K,2008 低热量饮食 全员参加，达到预定目标则纳入减重组
表3 纳入文献的偏倚风险评价结果
纳入研究 队列的选择 可比性 结果 总计
① ② ③ ④ ⑤a ⑤b ⑥ ⑦ ⑧
Monfared S, 2020 1 0 1 1 1 0 1 1 1 7
Chinaka U,2019 1 1 1 1 1 0 1 1 1 8
Stefura T,2019 1 1 1 1 1 0 1 1 1 8
Tan SYT,2020 1 1 1 1 0 0 1 1 1 7
Hutcheon DA,2018 1 1 1 1 1 1 1 1 1 9
Riess KP,2008 1 1 1 1 1 1 1 1 1 9
Harnisch MC,2008 1 0 1 1 1 0 1 1 1 7
Huerta S,2008 1 0 1 1 1 0 1 1 1 7
Fujioka K,2008 1 0 1 1 1 0 1 1 1 7
图2 术前合并症改善
图3 术中腔镜中转
图4 手术时间
图5 术后早期并发症
图6 术后出血
图7 术后伤口感染
图8 非计划二次手术
图9 住院时间
图10 术后合并症改善
图11 术后3月体重减轻
图12 术后6月体重减轻
图13 术后12月体重减轻
图14 术后早期并发症的偏倚分析
1
王勇, 王存川, 朱晒红, 等. 中国肥胖及2型糖尿病外科治疗指南（2019版） [J]. 中国实用外科杂志, 2019, 39(04): 301-306.
2
顾岩, 王勇, 沈奇伟, 等. 腹腔镜减重代谢手术前进行减重的必要性 [J]. 中国实用外科杂志, 2020, 40(4): 415-417.
3
Schneider A, Hutcheon DA, Hale A, et al. Postoperative outcomes in bariatric surgical patients participating in an insurance-mandated preoperative weight management program [J]. Surgery for Obesity and Related Diseases, 2018, 14(5): 623-630.
4
Pratt KJ, Jalilvand A, Needleman B, et al. Postoperative outcomes based on patient participation in a presurgery education and weight management program [J]. Surgery for Obesity and Related Diseases, 2018, 14(11): 1714-1723.
5
Parikh M, Dasari M, Mcmacken M, et al. Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study [J]. Surgical Endoscopy, 2012, 26(3): 853-861.
6
Liu RC, Sabnis AA, Forsyth C, et al. The effects of acute preoperative weight loss on laparoscopic roux-en-y gastric bypass [J]. Obesity Surgery, 2005, 15(10): 1396-1402.
7
Keith , Charles J, et al. Insurance-mandated preoperative diet and outcomes after bariatric surgery[J]. Surgery for Obesity and Related Diseases, 2018, 14(5): 631-636.
8
Mohammad K, Jamal EJ, De Maria JM, et al. Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity [J]. Surgery for Obesity and Related Diseases, 2006, 2(2): 122-127.
9
Chakravartty S, Vivian G, Mullholland N, et al. Pre-operative liver shrinking diet for bariatric surgery may impact wound healing: a randomised controlled trial [J]. Surgery for Obesity and Related Diseases, 2019, 15(1): 117-125.
10
Ekici U, Ferhatoglu MF. Perioperative and postoperative effects of preoperative low-calorie restrictive diets on patients undergoing laparoscopic sleeve gastrectomy [J]. Journal of Gastrointestinal Surgery, 2020, 24(2): 313-319.
11
Nieuwenhove YV, Da Mbrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study [J]. Archives of Surgery, 2011, 146(11): 1300-1305.
12
Alvarado R, Alami R, Hsu G, et al. The imPact of Preoperative weight loss in Patients undergoing laParoscoPic Roux-en-Y gastric byPass [J]. Obesity surgery, 2005, 15(9): 1282-1286.
13
Kalarchian M, Marcus M, Courcoulas A, et al. PreoPerative lifestyle intervention in bariatric surgery: a randomized clinical trial [J]. Surgery for Obesity and Related Diseases, 2016, 12(1): 180-187.
14
Martin L, Tan T, Holmes P, et al. Can morbidly obese patients safely lose weight preoperatively? [J]. American Journal of Surgery, 1995, 169(2): 245-253.
15
UC , JF , AA . Does preoperative weight loss predict significant postoperative weight loss among patients who underwent laparoscopic sleeve gastrectomy? [J]. Cureus, 2019, 11(10): e5870.
16
Stefura T, Droś J, Kacprzyk A, et al. Influence of preoperative weight loss on outcomes of bariatric surgery for patients under the enhanced recovery after surgery protocol [J]. Obesity Surgery, 2019, 29(4): 1134-1141.
17
Tan S, Loi PL, Lim CH, et al. Preoperative weight loss via very low caloric diet (VLCD) and its effect on outcomes after bariatric surgery [J]. Obesity Surgery, 2020, 30(6): 2099-2107.
18
Hutcheon DA, Hale AL, Ewing JA, et al. Short-term preoperative weight loss and postoperative outcomes in bariatricSurgery [J]. Journal of the American College of Surgeons, 2018, 226(4): 514-524.
19
Riess KP, Baker MT, Lambert PJ, et al. Effect of preoperative weight loss on laparoscopic gastric bypass outcomes [J]. Surgery for Obesity & Related Diseases, 2008, 4(6): 704-708.
20
Harnisch MC, Portenier DD, Pryor AD, et al. Preoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity [J]. Surgery for Obesity & Related Diseases, 2008, 4(3): 445-450.
21
Huerta S, Dredar S, Hayden E, et al. Preoperative weight loss decreases the operative time of gastric bypass at a veterans administration hospital[J]. Obesity Surgery, 2008, 18(5):508-512.
22
KF , EY , HJ W, et al. Evaluating PreoPerative weight loss, binge eating disorder, and sexual abuse history on Roux-en-Y gastric byPass outcome [J]. Surgery for Obesity and Related Diseases, 2008, 4(2): 137-143.
23
Monfared S, Athanasiadis DI, Furiya A, et al. do mandated weight loss goals prior to bariatric surgery improve postoperative outcomes? [J]. Obesity Surgery, 2020, 30(3): 889-894.
24
Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial [J]. Surgery for Obesity and Related Diseases, 2007, 3(2): 141-145.
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