نتايج و عوارض حلقه معده در درمان چاقي مفرط

Results and Complications of Gastric Banding in the Treatment of Morbid Obesity

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺑﻪ ﺩﻧﺒﺎﻝ ﺷﮑﺴﺖ ﻭ ﻋﺪﻡ ﮐﺎﺭﺍﻳﻲ ﺭﻭﺵ ﻫﺎﻱ ﻏﻴﺮ ﺟﺮﺍﺣﻲ ﺩﺭ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﭼﺎﻗﻲ ﻣﻔﺮﻁ، ﺭﻭﺵ ﻫﺎﻱ ﻧﻮﻳﻦ ﺟﺮﺍﺣﻲ ﺟﻬﺖ ﮐﻤﮏ ﺑﻪ ﺑﻴﻤﺎﺭﺍﻥ ﻣﻌﺮﻓﻲ ﮔﺮﺩﻳﺪ. ﮔﺬﺍﺷﺘﻦ ﺣﻠﻘﻪ ﻣﻌﺪﻩ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻭﺵ ﻻﭘﺎﺭﻭﺳﮑﻮﭘﻲ ﻳﮑﻲ ﺍﺯ ﺭﻭﺵ ﻫﺎﻱ ﻣﻮﺭﺩ ﻋﻼﻗﻪ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﭘﺰﺷﮑﺎﻥ ﺩﺭ ﺳﺎﻝ ﻫﺎﻱ ﺍﺧﻴﺮ ﺑﻮﺩﻩ ﺍﺳﺖ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﻪ ﻣﻨﻈﻮﺭ ﺑﺮﺭﺳﻲ ﻧﺘﺎﻳﺞ ﻭ ﻳﺎﻓﺘﻪ ﻫﺎﻱ ﺍﻳﻦ ﺭﻭﺵ ﻭ ﻧﻴﺰ ﻋﻮﺍﺭﺽ ﻧﺎﺷﻲ ﺍﺯ ﺁﻥ ﺩﺭ 165 ﺑﻴﻤﺎﺭ ﻣﺮﺍﺟﻌﻪ ﮐﻨﻨﺪﻩ ﺑﻪ ﻳﮑﻲ ﺍﺯ ﻣﺮﺍﮐﺰ ﺧﺼﻮﺻﻲ ﺩﺭ ﺍﻳﺮﺍﻥ ﻃﺮﺍﺣﻲ ﺷﺪﻩ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻳﮏ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﻲ ﺑﻮﺩﻩ ﮐﻪ ﺩﺭ ﻓﺎﺻﻠﻪ ﺳﺎﻝ ﻫﺎﻱ 1390 - 1384 ﺑﺮ ﺭﻭﻱ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺒﺘﻼ ﺑﻪ ﭼﺎﻗﻲ ﺑﺎ ﺷﺎﺧﺺ ﺗﻮﺩﻩ ﺑﺪﻧﻲ 50 - 32 ﮐﻴﻠﻮﮔﺮﻡ ﻣﺘﺮ ﻣﺮﺑﻊ ﮐﻪ ﺗﺤﺖ ﺩﺭﻣﺎﻥ ﺑﺎ ﺭﻭﺵ ﮔﺬﺍﺷﺘﻦ ﺣﻠﻘﻪ ﻣﻌﺪﻩ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻻﭘﺎﺭﻭﺳﮑﻮﭘﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺑﻮﺩﻧﺪ، ﺻﻮﺭﺕ ﮔﺮﻓﺘﻪ ﺍﺳﺖ. ﻋﻮﺍﺭﺽ ﺍﺣﺘﻤﺎﻟﻲ ﺩﺭ ﻃﻮﻝ ﺩﻭﺭﻩ ﭘﻴﮕﻴﺮﻱ ﺑﻴﻤﺎﺭﺍﻥ ﺛﺒﺖ ﻣﻲ ﮔﺮﺩﻳﺪ. ﺩﺭ ﺁﻧﺎﻟﻴﺰ ﻧﺘﺎﻳﺞ ﺍﺯ ﺷﺎﺧﺺ ﻫﺎﻱ ﺁﻣﺎﺭﻱ ﻓﺮﺍﻭﺍﻧﻲ ﻭ ﻧﻴﺰ ﺗﺴﺖ ﻫﺎﻱ ﺁﻣﺎﺭﻱ ﮐﺎﻱ ﺍﺳﮑﻮﺍﺭ ﻭ T-Test ﺍﺳﺘﻔﺎﺩﻩ ﮔﺮﺩﻳﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻴﺎﻧﮕﻴﻦ ﺯﻣﺎﻥ ﺍﻧﺠﺎﻡ ﺟﺮﺍﺣﻲ، ﺍﺯ ﺯﻣﺎﻥ ﻭﺭﻭﺩ ﺍﻭﻟﻴﻦ ﭘﻮﺭﺕ ﺗﺎ ﺯﻣﺎﻥ ﺁﺧﺮﻳﻦ ﮔﺮﻩ ﺑﺨﻴﻪ، 20/1±2/3 ﺩﻗﻴﻘﻪ، ﻣﻴﺎﻧﮕﻴﻦ ﺯﻣﺎﻥ ﺑﺴﺘﺮﻱ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ 17/8±0/8 ﺳﺎﻋﺖ ﻭ ﻣﻴﺎﻧﮕﻴﻦ ﺯﻣﺎﻥ ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﮐﺎﺭ 6/1±0/4 ﺭﻭﺯ ﺑﻮﺩﻩ ﺍﺳﺖ. ﻣﻴﺎﻧﮕﻴﻦ ﮐﺎﻫﺶ ﻭﺯﻥ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﺯﻣﺎﻥ ﭘﻴﮕﻴﺮﻱ 21/4±0/9 ﮐﻴﻠﻮﮔﺮﻡ ﺑﻮﺩﻩ ﺍﺳﺖ. ﺍﺯ ﻣﻴﺎﻥ 165 ﺑﻴﻤﺎﺭ ﻣﺒﺘﻼ ﺑﻪ ﭼﺎﻗﻲ، 39 ﺑﻴﻤﺎﺭ23/6 ﺩﭼﺎﺭ ﻋﻮﺍﺭﺽ ﺷﺪﻧﺪ. 21 ﻣﻮﺭﺩ )12/7 ﺟﺎﺑﺠﺎﻳﻲ ﺣﻠﻘﻪ، 11 ﻣﻮﺭﺩ 6/6 ﻋﻔﻮﻧﺖ ﭘﻮﺭﺕ ﻭ 6 ﻣﻮﺭﺩ3/6 ﺍﻳﺠﺎﺩ ﺯﺧﻢ ﺩﺭ ﻣﻌﺪﻩ ﻭ ﻳﮏ ﻣﻮﺭﺩ )0/6 ﺗﺤﺮﻳﮏ ﻋﺼﺐ ﻓﺮﻧﻴﮏ ﺩﺭ ﻃﻮﻝ ﻣﺪﺕ 16/9±0/9 ﻣﺎﻩ ﭘﻴﮕﻴﺮﻱ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺭﺥ ﺩﺍﺩﻩ ﺑﻮﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻭﺵ ﻫﺎﻱ ﻧﻮﻳﻦ ﺟﺮﺍﺣﻲ ﭼﺎﻗﻲ ﻣﻲ ﺗﻮﺍﻧﺪ ﺑﻪ ﻋﻨﻮ ﺍﻥ ﻳﮑﻲ ﺍﺯ ﺭﺍﻫﮑﺎﺭﻫﺎﻱ ﻣﻨﺎﺳﺐ ﺟﻬﺖ ﮐﺎﻫﺶ ﻭﺯﻥ، ﻣﻮﺭﺩ ﺗﻮﺟﻪ ﻗﺮﺍﺭ ﮔﻴﺮﺩ. ﺍﻧﺘﺨﺎﺏ ﺻﺤﻴﺢ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺍﺭﺍﺋﻪ ﺗﻮﺿﻴﺤﺎﺕ ﮐﺎﻓﻲ ﺩﺭ ﻣﻮﺭﺩ ﻋﻮﺍﺭﺽ ﻋﻤﻞ ﻣﻲ ﺗﻮﺍﻧﺪ ﺑﻪ ﺑﻬﺒﻮﺩ ﺭﻭﻧﺪ ﺩﺭﻣﺎﻧﻲ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺍﻧﺘﻈﺎﺭ ﻭﺍﻗﻊ ﺑﻴﻨﺎﻧﻪ ﺍﺯ ﻧﺘﺎﻳﺞ ﺩﺭﻣﺎﻥ ﮐﻤﮏ ﻧﻤﺎﻳﺪ.

Introduction & Objective: Following the failure of non-surgical techniques, surgical approaches have been introduced in order to help morbid obese patients to achieve their optimal weight. Laparoscopic adjustable gastric banding (LAGB) has been considered as one of the most favorable methods among both patients and surgeons. The recent article is a report of 165 patients who underwent LAGB when referred to a private medical center. Materials & Methods: This study was a cross-sectional, performed between January 2005 and February 2012 on 165 obese patients with body mass index (BMI) between 32 and 50 kg/m2, and who had undergone LAGB. The subsequent complications were recorded during the patient’s follow-up periods. Analytic analysis was performed using frequency indices and Chi square and T-tests. Results: The mean operation time from the insertion of the first port to the final suture was 20.1±2.3 minutes. The mean hospital stay was 17.8±0.8 hours and the mean time to return to work was 6.1±0.4 days. The mean weight reduction was 21.4±0.9 kg. Thirty-nine patients (23.6%) experienced complications, including 21 (12.7%) slippages, 11 (6.6%) port infections,6 (3.6%) erosions and one (0.6%) phrenic nerve irritation during the 16.9±0.9 months follow-up period. Conclusions: Using new modalities in surgical treatments can be one of the most appropriate treatments to reduce weight. Appropriate case selections and describing the complications to patients, may be helpful in reducing the side effects and obtaining more realistic findings