副甲狀腺素與規律就醫對不同外科減重手術術後效果影響

研究背景與目的：減重手術是可立竿見影治療肥胖的方法之一，然而術後可能因營養狀況不良和腸胃吸收功能不佳，而引起次發性副甲狀腺功能亢進。對接受減重手術的患者而言，腸胃道吸收營養的不良可能會影響到完整性副甲狀腺素的分泌增加，進而影響減重效果的表現。且不論接受何種減重手術，規律就醫回診追蹤，以及遵從醫療建議和監測術後營養狀態的重要性都不容忽視。從是否遵循規律就醫回診，持續監測體內營養指數及生化數值，進而探討及維持術後理想減重效果。研究方法：本研究採回溯病歷研究設計，分析南台灣某地區醫院符合健保局規範可執行腹腔鏡減重手術且術後滿一年患者就診資料，總共納入392位患者。研究變項包括人口學、手術方式、完整性副甲狀腺素、有無規律就醫回診及疾病變項，減重成效指標包括：多餘流失體重百分比及總減重百分比，等列為預測因子，進行描述性統計、獨立樣本t檢定、相關分析和廣義估計方程式分析。在分析中，定義p<0.05作為達到統計上顯著差異的標準，找出副甲狀腺素與規律就醫對不同外科減重手術術後效果影響之預測因素。結果：研究結果顯示，年齡平均值±標準差為37.08±9.9；女性佔多數64%；腹腔鏡胃袖狀切除術佔88.8%，單吻合胃繞道手術佔11.2%；有規律就醫回診佔63.3%；在獨立樣本t檢定中，不同減重手術方式與完整性副甲狀腺素術後數值結果顯示，完整性副甲狀腺素術後三個月（p=0.007）、六個月（p=0.014）、一年（p=0.006），均具有顯著性；術前至術後十二個月的總減重百分比與規律就醫回診具有顯著差異(p=0.022)；於廣義估計方程式分析中完整性副甲狀腺素與多餘流失體重百分比呈現負相關（p=0.009），完整性副甲狀腺素與總減重百分比亦呈負相關（p=0.011），不同手術方式與總減重百分比具顯著性（p=0.002），以上呈現統計顯著差異。結論：研究結果發現，本研究分析結果以腹腔鏡迷你胃繞道手術的減重成效較好，且腹腔鏡迷你胃繞道手術的完整性副甲狀腺素平均值高於腹腔鏡胃袖狀切除術，研究結果也呈現減重成效好的病人較有可能出現次發性副甲狀腺亢進症的結論，但推論術後的規律追蹤及營養諮詢的配合度亦與減重效果有顯著的相關性，因此雖然腹腔鏡迷你胃繞道手術的完整性副甲狀腺素數值平均較高，但也有良好的減重效果。藉研究結果發現，期望為醫療機構管理和治療策略制定提供參考，以提升術後減重成效，以進一步改善病人的術後減重效果及維持優良身心健康狀態。

關鍵字

副甲狀腺亢進；規律回診；減重手術；多餘流失體重百分比；總減重百分比

並列摘要

Research background and purpose: Bariatric surgery is one of the methods that can treat obesity immediately. However, postoperative malnutrition and poor gastrointestinal absorption may cause secondary hyperparathyroidism. For patients undergoing bariatric surgery, poor gastrointestinal absorption of nutrients may affect the increase in the secretion of complete parathyroid hormone, thereby affecting the performance of weight loss. And no matter what kind of weight loss surgery you receive, the importance of regular follow-up visits to the doctor, as well as following medical advice and monitoring the nutritional status after surgery cannot be ignored. From whether to follow the rules to go to the doctor to return to the clinic, to continuously monitor the nutritional index and biochemical values in the body, and then to explore and maintain the ideal weight loss effect after surgery. Research method: This study adopts a retrospective medical record research design, and analyzes the medical data of patients who can perform laparoscopic bariatric surgery in accordance with the National Health Insurance Bureau's regulations in a hospital in southern Taiwan. A total of 392 patients were included. The research variables include demographics, surgical methods, complete parathyroid hormone, regular medical visits, and disease variables. The weight loss effectiveness indicators include: the percent excess wight loss and the percentage of total weight loss, etc. are listed as predictive factors. Descriptive statistics, independent sample t-test, correlation analysis, and generalized estimating equation analysis. In the analysis, p<0.05 was defined as the standard to achieve a statistically significant difference to find out the predictors of parathyroid hormone and regular medical visits on the postoperative outcomes of different surgical bariatric surgeries. Results: The results of the study showed that the mean ± standard deviation of age was 37.08 ± 9.9; women accounted for the majority of 64%; laparoscopic sleeve gastrectomy accounted for 88.8%, gastric bypass surgery with single anastomosis accounted for 11.2%; regular medical return accounted for 63.3% ; In the independent sample t test, the numerical results of different bariatric surgery methods and complete parathyroid hormone postoperative showed that the complete parathyroid hormone postoperative three months (p=0.007), six months (p=0.014) , one year (p=0.006), both were significant; there was a significant difference between the total weight loss percentage from preoperative to 12 months postoperative and regular medical visits (p=0.022); in the generalized estimating equation analysis, the integrity Parathyroid hormone was negatively correlated with excess weight loss percentage (p=0.009), intact parathyroid hormone was also negatively correlated with total weight loss percentage (p=0.011), and different surgical methods were significantly correlated with total weight loss percentage (p =0.002 ), the above showed a statistically significant difference. Conclusion: The results of the study found that laparoscopic mini-gastric bypass surgery has a better weight loss effect, and the mean value of complete parathyroid hormone in laparoscopic mini-gastric bypass surgery is higher than that of laparoscopic sleeve gastric resection. The results also show that patients with good weight loss results are more likely to develop secondary hyperparathyroidism. However, it is inferred that the follow-up of postoperative regularity and the degree of cooperation in nutritional counseling are also significantly related to the weight loss effect. Therefore, although the abdominal cavity Endoscopic mini-gastric bypass surgery had a mean of higher integrity parathyroid hormone values, but also had good weight loss. Based on the findings of the study, it is expected to provide a reference for the management and treatment strategy formulation of medical institutions, so as to improve the effect of postoperative weight loss, so as to further improve the effect of postoperative weight loss of patients and maintain a good physical and mental health.