| 摘要: | 減重手術對病態性肥胖病人為有效且可長期控制體重的方式，在本土研究中，減重手術術後體組成合併性別分析的文獻較少。本研究目的為瞭解病態性肥胖病人經胃袖狀切除術 (SG) 及調整型胃束帶手術 (AGB)，在不同性別之體組成變化，為臺灣單一醫院之病歷回顧研究。研究共收錄 198 位個案，其中完成一年追蹤者，SG 組個案有 81 名，男性為 21 名，女性為 60 名；AGB 組個案有 40 名，男性為 21 名，女性為 19 名。體組成以生物電阻抗技術方式取得。結果顯示，兩組在術後體重均隨時間顯著減輕。在身體質量指數 (BMI) 下降、脂肪量 (FM) 下降、超重體重下降百分比 (%EWL)、除脂量校正體重 (FFMw) 增加、骨骼肌量校正體重 (SMMw) 增加，SG組較 AGB 組顯著。而 SG 組之除脂量 (FFM) 及骨骼肌量 (SMM) 在術後第三個月降低較多。其中 FFM、SMM、腰臀比 (WHR) 及FFMw，不具有性別及手術交互作用。AGB 組中，包括BMI、FM、WHR、體重下降百分比 (%WL)、%EWL、脂肪量校正體重 (FMw)、SMMw 等結果，女性改善較男性顯著。SG 組之空腹血糖、三酸甘油酯，在術後第三個月顯著降低，而高密度脂蛋白膽固醇，則隨時間顯著增加。在複迴歸逐步分析體組成之血糖改善因子中，%EWL 對兩性減重後的血糖改善具有影響力，而 FFMw 增加會影響女性減重後的血糖改善。未來需建議 SG 減重手術個案，在術後初期三個月補充適當營養補充品，以避免除脂量及骨骼肌量流失。
Bariatric surgery is considered to be an effective treatment in long-term weight control. However, the changes of body composition between genders after surgery were rarely investigated. The purpose of this study is to evaluate the effect of gender on body composition changes after sleeve gastrectomy (SG) or adjustable gastric banding (AGB) surgery in morbidly obese subjects. This is a retrospective observational chart review performed in one hospital in Taiwan. At the beginning, 198 subjects were enrolled. A total of 81 subjects with SG (21 male and 60 female) and 40 receiving AGB (21 male and 19 female) were followed up for one year. Body composition was measured by bioelectrical impedance analysis. The results showed that all subjects experienced significant weight loss after their operations. Compared to AGB, subjects with SG had a greater extent of body mass index (BMI) loss, fat mass (FM) loss, percentage of excess weight loss (%EWL), increased adjusted fat-free mass by weight (FFMw) and adjusted skeletal muscle mass by weight (SMMw). Especially, fat-free mass (FFM) and skeletal muscle mass (SMM) lose significantly in the first three months after the SG. There were no differences in FFM, SMM, waist/hip ratio (WHR), FFMw between genders and surgery. However, the BMI, FM, WHR, %WL, %EWL, adjusted FM by weight (FMw), and SMMw were significantly improved in females rather than males in AGB. Fasting glucose, triglycerides decreased significantly after three months among SG. Otherwise, the high-density lipoprotein cholesterol increased significantly over time. Multivariable stepwise regression analyses that the glucose level improvement was related with change of %EWL, and FFMw increasing only in female. In the future, we need to suggest nutritional supplement for SG patients to avoid FFM and SMM loss. |
