醫病共享決策輔助工具

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我需要接受減重手術,除了胃束帶手術外,還有其他手術選擇嗎?

科別 外科
主題類別 消化系統
決策類型 治療
關鍵字 胃袖狀切除術、胃繞道手術、Laparoscopic Roux-en-Y Gastric Bypas、laparoscopic sleeve gastrectomy
適用病人條件 BMI>40kg/m2或BMI介於35-39.9kg/m2且至少合併一種嚴重合併症(如睡眠呼吸中止、呼吸喘等)的成年人,透過飲食控制、運動及藥物治療BMI仍未下降至標準範圍之病人。 排除有頑固性胃潰瘍、胃癌家族史、嚴重胃食道逆流及曾接受過胃部手術之病人。
可供選擇決策方案 (一) 胃袖狀切除術,(二) 胃繞道手術,(三) 胃束帶手術
使用場所 診間
執行者 醫師、護理師
開發團隊、機構 奇美醫院財團法人佳里奇美醫院
輔助工具研發過程說明

一、目標
本研發報告之目的為利用決策輔具工具,幫助肥胖之民眾決定減重手術之方式
目標族群:BMI≧40,或BMI介於35-39且有嚴重合併症之病人
主要目的:1. 了解肥胖的病因
2. 了解手術間的差異並做出決策
二、內容要點
1. 依據102-105年「國民營養健康狀況變遷調查」,我國成人過重及肥胖盛行率為45.4%,肥胖易引起糖尿病、腦血管疾病及心臟病等
2. 根據文獻顯示胃繞道手術對於糖尿病緩解程度較胃袖狀切除術佳
三、對象範圍
於門診諮詢減肥手術之病人,其BMI 大於等於40或介於35-39間並有嚴重合併症
四、實施方式:於一般及消化外科門診中,由醫師給予決策輔助表
五、實施期間:2019/09/01-2019/12/31
六、執行團隊:一般消化外科醫師、專科護理師、護理師、品管中心
七、所需經費:無
八、預期效益
1. 欲執行減肥手術之病人對於手術內容能更加了解
2. 縮短門診中反覆解釋手術差異的時

參考文獻

Colquitt, J. L., Pickett, K., Loveman, E., & Frampton, G. K. (2014). Surgery for weight loss in adults. Cochrane Database Syst Rev(8), Cd003641. doi:10.1002/14651858.CD003641.pub4
Li, J., Lai, D., & Wu, D. (2016). Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy to Treat Morbid Obesity-Related Comorbidities: a Systematic Review and Meta-analysis. Obes Surg, 26(2), 429-442. doi:10.1007/s11695-015-1996-9
Lin, Y., Long, Y., Lai, S., Zhang, Y., Guo, Q., Huang, J., & Du, L. (2019). The Effectiveness and Safety of Barbed Sutures in the Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg, 29(6), 1756-1764. doi:10.1007/s11695-019-03744-4
Magouliotis, D. E., Tasiopoulou, V. S., Svokos, A. A., Svokos, K. A., Sioka, E., & Zacharoulis, D. (2017). Roux-En-Y Gastric Bypass versus Sleeve Gastrectomy as Revisional Procedure after Adjustable Gastric Band: a Systematic Review and Meta-Analysis. Obes Surg, 27(5), 1365-1373. doi:10.1007/s11695-017-2644-3
Osland, E., Yunus, R. M., Khan, S., Alodat, T., Memon, B., & Memon, M. A. (2016). Postoperative Early Major and Minor Complications in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review. Obes Surg, 26(10), 2273-2284. doi:10.1007/s11695-016-2101-8
Osland, E., Yunus, R. M., Khan, S., Memon, B., & Memon, M. A. (2016). Late Postoperative Complications in Laparoscopic Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-y Gastric Bypass (LRYGB): Meta-analysis and Systematic Review. Surg Laparosc Endosc Percutan Tech, 26(3), 193-201. doi:10.1097/sle.0000000000000279
Osland, E., Yunus, R. M., Khan, S., Memon, B., & Memon, M. A. (2017). Weight Loss Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech, 27(1), 8-18. doi:10.1097/sle.0000000000000374
Rausa, E., Kelly, M. E., Galfrascoli, E., Aiolfi, A., Cavalcoli, F., Turati, L., . . . Sgroi, G. (2019). Quality of Life and Gastrointestinal Symptoms Following Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy: a Systematic Review. Obes Surg, 29(4), 1397-1402. doi:10.1007/s11695-019-03737-3
Shoar, S., & Saber, A. A. (2017). Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies. Surg Obes Relat Dis, 13(2), 170-180. doi:10.1016/j.soard.2016.08.011
Zhao, K., Liu, J., Wang, M., Yang, H., & Wu, A. (2019). Safety and efficacy of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: A systematic review and meta-analysis. J Eval Clin Pract. doi:10.1111/jep.13170

版本 2020