【摘要】 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。更多还原

【Abstract】 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.更多还原