Zusammenfassung
Hintergrund: Mit einer Häufigkeit von 6–10 % bei prämenopausalen Frauen stellt das polyzystische Ovarsyndrom (PCOS) die häufigste Ursache der Infertilität und darüber hinaus die häufigste endokrine Erkrankung dar. Vor allem die metabolischen und kardiovaskulären Folgen bedeuten ein erhebliches Gesundheitsproblem. Im Mittelpunkt der Pathophysiologie steht die viszerale Adipositas und nachfolgend die Insulinresistenz. Dies unterstreicht die Bedeutung von Maßnahmen zur Reduktion der abdominellen Adipositas. Methoden: Zwischen Februar 1995 und Oktober 2006 unterzogen sich 204 Patienten am SRH Wald-Klinikum Gera bariatrischen Eingriffen. Hiervon waren 75 % der Patienten weiblich. Drei Patientinnen hatten ein PCO-Syndrom assoziiert mit Veränderungen des metabolischen Syndroms. Ergebnisse: Nach laparoskopischem Gastric Banding hatten diese drei Patientinnen eine Excess-Body-Weight-Loss (EBWL) von 49, 67 bzw. 41 % ihres Übergewichts bei einer mittleren postoperativen Nachbeobachtungszeit von 104 Monaten. Die diabetische Stoffwechsellage bildete sich hierbei vollständig zurück. Eine Patientin wurde nach erfolgreicher Gewichtsreduktion schwanger. Fazit: Bei Vorliegen des PCO-Syndroms sind bariatrische Eingriffe eine Therapiemöglichkeit zur Gewichtsreduktion. Hieraus resultiert auch eine Reduktion der Komorbiditäten, der Insulinresistenz und eine Verbesserung des metabolischen Syndroms sowie der Fertilität.
Abstract
Background: The polycystic ovary syndrome (PCOS) is the most frequent cause of female infertility with an estimated prevalence of 6–10 % in premenopausal women. Due to its long-term metabolic and cardiovascular consequences, it poses a severe health problem. Visceral obesity and subsequent insulin resistance represent the core pathophysiology of PCOS, clearly suggesting that measures to reduce abdominal obesity should be pursued. Methods: Between February 1995 and October 2006, 204 patients underwent bariatric surgery in the SRH Hospital of Gera. 75 % of the patients were female and three of them were suffering preoperatively from polycystic ovary syndrome and metabolic syndrome. Results: 104 months after laparoscopic adjustable gastric banding, the excess body weight loss (EBWL) was 49, 67 and 41 % in these three patients, respectively. Glucose levels normalised completely. One patient became pregnant after weight reduction. Conclusions: In PCOS with metabolic syndrome, bariatric surgery is an option to reduce weight and to treat associated metabolic disorders. Surgery should be performed based on the body mass index, the metabolic disorders, and the wish of the patient to become pregnant.
Schlüsselwörter
morbide Adipositas - PCO-Syndrom - metabolisches Syndrom - bariatrische Chirurgie - gastric Banding
Key words
morbid obesity - PCO syndrome - metabolic syndrome - bariatric surgery - gastric banding
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Dr. C. Stroh
Departement für Allgemein- und Visceralchirurgie · SRH Wald-Klinikum Gera gGmbH
Straße des Friedens 122
07548 Gera
Phone: 03 65 / 8 28 31 01
Fax: 03 65 / 8 28 31 02
Email: Christine.Stroh@wkg.srh.de
