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Jama Inter med:减重手术可改善肥胖导致的尿失禁

来源:生物谷 2015-06-25 09:33

                                                                  

2015年6月25日讯 /生物谷BIOON/ --最近,来自美国加州大学旧金山分校的研究人员进行了一项研究,他们发现对于一些极度肥胖的人来说,减重手术除了能够减轻体重还能为患者带来一些其他获益:大大降低尿失禁的发生。近日,相关研究结果发表在国际学术期刊JAMA Internal Medicine上。
 
这项由加州大学旧金山分校的研究人员领导的最新调查研究对进行了减重手术的肥胖患者进行了3年的跟踪调查,首次对减重手术对尿失禁的长期影响进行了报道。
 
之前一些研究表明,通过几种减重方法--低卡路里饮食、运动减肥以及减重手术--都与肥胖患者在进行减重的第一年内尿失禁情况增加有关。但一直以来都没有研究对这些方法的长期影响提供证据。因此,研究人员想要对减重手术对尿失禁情况的长期影响进行研究,并希望发现一些与尿失禁情况改善有关的因素。
 
在该项研究中,研究人员对2005年~2009年间大约2000名进行了减重手术的病人进行了问卷调查,询问一些关于尿失禁的情况。结果表明有接近一半的女性患者和超过五分之一的男性患者在手术之前存在每周至少一次尿失禁的情况。
 
参与该项研究的研究对象年龄跨度在18~78岁之间,中位年龄为47岁,并且有接近79%的参与者为女性。这些肥胖患者在进行了减重手术之后,女性减重幅度达到29%,男性达到26%,除了体重得到减轻以外,大部分参与者在手术后三年,尿失禁的情况也得到实质性改善。
 
相比较而言,年龄较大并且行动不便的患者以及最近怀孕的手术患者尿失禁改善的情况不是十分明显。
 
总得来说,这项研究通过跟踪观察发现减重手术除了能够减轻病人体重,从长期作用来看还可以改善尿失禁情况,为肥胖的临床治疗提供了有用信息。(生物谷Bioon.com)
 
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Urinary Incontinence Before and After Bariatric Surgery
 
Leslee L. Subak, MD1,2,3,4; Wendy C. King, PhD5; Steven H. Belle, PhD, MScHyg5,6; Jia-Yuh Chen, MS6; Anita P. Courcoulas, MD, MPH7; Faith E. Ebel, RD, MS, MPH8; David R. Flum, MD, MPH9; Saurabh Khandelwal, MD9; John R. Pender, MD10; Sheila K. Pierson, BS7; Walter J. Pories, MD10; Kristine J. Steffen, PharmD, PhD11; Gladys W. Strain, PhD8; Bruce M. Wolfe, MD12; Alison J. Huang, MD, MAS
 
Importance  Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking.
 
Objectives  To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery.
 
Design, Setting, and Participants  The Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012).
 
Intervention  Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter.
 
Main Outcomes and Measures  The frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up.
 
Results  Of 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m2 (range, 34-94 kg/m2), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P?<?.001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P?<?.001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P?<?.001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation.
 
Conclusions and Relevance  Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.
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