减重手术后肺栓塞患病率的系统评价与Meta分析
该系统评价与Meta分析纳入9项研究共1,080,346例接受代谢减重手术的成人患者，汇总肺栓塞患病率为每1000例手术3.70例（95%CI：1.71-6.30），异质性较高（I²=99.48%）。亚组分析显示开放手术患病率最高（7.58/1000），腹腔镜手术最低（1.90/1000）。
要点
- 减重术后肺栓塞汇总患病率为每1000例手术3.70例（95%CI：1.71-6.30）
- 开放手术肺栓塞患病率（7.58/1000）高于腹腔镜手术（1.90/1000）
- 围术期应警惕肺栓塞，开放手术尤需个体化血栓预防
核心结论
- 肺栓塞是代谢减重手术后不常见但具有临床意义的并发症，其风险受手术方式显著影响。
- 研究结果强调围术期需保持警惕并制定个体化血栓预防策略，尤其针对开放手术。
研究设计与样本
- 系统评价与Meta分析，遵循PRISMA指南并在PROSPERO注册。
- 纳入报告成人（≥18岁）减重术后肺栓塞的观察性研究与随机对照试验，术式包括袖状胃切除、Roux-en-Y胃旁路和可调节胃束带。
- 共纳入9项研究、1,080,346例患者。
主要发现
- 代谢减重手术后肺栓塞汇总患病率为每1000例手术3.70例（95%CI：1.71-6.30），异质性显著（I²=99.48%）。
- 开放减重手术患病率最高，为每1000例7.58例（95%CI：4.10-11.99）。
- 手术方式未报告的术式患病率为每1000例2.97例（95%CI：0.76-6.62）。
- 腹腔镜手术患病率最低，为每1000例1.90例（95%CI：0.00-5.95）。
- 前瞻性与回顾性研究的患病率估计相近。
临床怎么用
- 对减重手术患者应重视围术期肺栓塞风险评估与监测。
- 开放手术患者血栓风险更高，应考虑更有针对性的血栓预防措施。
局限性
- 纳入研究间异质性极高（I²=99.48%），可能影响汇总估计的稳健性。
- 腹腔镜手术亚组置信区间下限为0.00，估计不确定性较大。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Obes Surg. 2026 Jun;36(6):3403-3414. doi: 10.1007/s11695-026-08733-y. Epub 2026 May 19. ABSTRACT BACKGROUND: Pulmonary embolism (PE) is a potentially life-threatening complication following bariatric surgery. Accurate estimates of its prevalence are essential to inform perioperative risk management and thromboprophylaxis strategies. METHODS: This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered in PROSPERO. Observational studies and randomized controlled trials reporting postoperative PE among adults (≥ 18 years) undergoing bariatric procedures-including sleeve gastrectomy, Roux-en-Y gastric bypass, and adjustable gastric banding-were included. RESULTS: Nine studies comprising 1,080,346 patients were included. The pooled prevalence of PE following metabolic-bariatric surgery (MBS) was 3.70 per 1000 procedures (95% CI: 1.71-6.30), with substantial heterogeneity (I² = 99.48%). Subgroup analysis revealed the highest prevalence in open bariatric surgery (7.58 per 1000; 95% CI: 4.10-11.99), intermediate in procedures with unreported surgical approach (2.97 per 1000; 95% CI: 0.76-6.62), and lowest in laparoscopic procedures (1.90 per 1000; 95% CI: 0.00-5.95). Prevalence estimates were similar between prospective and retrospective studies. CONCLUSION: PE is an uncommon but clinically significant complication after MBS, with risk strongly influenced by surgical technique. These findings emphasize the importance of vigilant perioperative monitoring and tailored thromboprophylaxis, particularly in open procedures. PMID: 42154212 | DOI: 10.1007/s11695-026-08733-y
引用
- PubMed 高证据 · 肺栓塞：Prevalence of Pulmonary Embolism After Bariatric Surgery: a Systematic Review and Meta-Analysis
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。