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摘要: 胃内球囊是一种无创的肥胖症治疗策略。通过在胃内放置球囊，限制容量和延缓胃排空可实现减重目的，临床上适用于单纯通过饮食和运动未能减重成功，或不愿意接受减重手术的肥胖症患者，也可用于减重手术术前先期减重的过渡性治疗。胃内球囊留置期内减重效果良好，严重并发症发生率低，但长期减重及改善代谢效果尚需更多临床研究加以验证。目前胃内球囊在我国尚未获批应用于临床。本文对胃内球囊的适应证、禁忌证、减重效果及相关并发症进行综述，以期指导临床实践。Abstract: The intragastric balloon (IGB), a non-invasive temporary method for obesity, can induce weight loss by placing a soft saline-or air-filled balloon in the stomach to reduce gastric capacity and delay gastric emptying. IGB is an option for individuals with obesity who have failed at weight management with diet and exercise or are unwilling to undergo bariatric surgery. Besides, IGB can also be used as a bridging intervention prior to bariatric surgery. IGB has been proven to be effective in inducing weight loss, with a low incidence of serious complications by clinical practice from foreign countries. However, the long-term follow-up for its effects on weight loss and metabolic improvement of IGB need to be verified in the future. The IGB has not been approved for clinical application in China. In this review, we discuss the indications and contraindications of IGB as well as its effects on weight loss and its complications.
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Key words:
- intragastric balloon /
- obesity /
- weight loss /
- treatment strategy
作者贡献：康军仁负责构思、起草、修订论文；徐强、李海龙负责查阅、整理文献资料，修订初稿和写作指导；魏薇负责查阅、整理文献资料及论文修订。利益冲突：所有作者均声明不存在利益冲突 -
表 1 常见胃内球囊及其特征
球囊种类 放置/移除 材质 球囊体积(mL) 球囊数目(个) 内容物 可调节 留置时间 批准上市机构 Orbera 胃镜/胃镜 硅胶 400~700 1 盐水+10 mL亚甲蓝 否 6个月 美国FDA Orbera365 胃镜/胃镜 硅胶 400~700 1 盐水+10 mL亚甲蓝 否 12个月 美国FDA ReShape Duo 胃镜/胃镜 硅胶 450/个 2 盐水 否 6个月 美国FDA Obalon 吞咽/胃镜 聚乙烯混合物 250/个 3 氮气 否 6个月 美国FDA Spatz3 胃镜/胃镜 硅胶 400~550 1 盐水 是 12个月 欧盟 Elipse 吞咽/自行排出 高分子聚合物 450~550 1 盐水 否 4个月 欧盟 FDA：食品药品监督管理局 
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表 2 常见胃内球囊减重效果及其并发症发生率(%)
球囊种类 取出时减重 恶心呕吐 不耐受提前移除 器械并发症 胰腺炎 胃溃疡 胃肠穿孔 肠梗阻 Orbera[27, 31-36] TWL：13.2/EWL：42.34 - 7.5~18.8 3.1 - 2 0.1 - Orbera365[30] TWL：16.2/EWL：54.6 - 14.4 7.2 2.1 - - - ReShape Duo[24, 28, 37] TWL：6.8~15.4/EWL：25.1~47.1 22.9 9 15 - 2.9~23.3 1.7 2.9 Obalon[38-39] TWL：7.1~10.3 91.1 0.22 0.18 - 0.2 0.07 - Spatz3[14, 26, 40-41] TWL：19/EWL：45.7 - 17~30 4.3 - 2.9~3.33 - - Elipse[25, 29, 42] TWL：12.8~14.2/EWL：49.1~67 - 2.3~3.6 0.6 0.06 0.06 0.05 0.15 TWL: 总体质量减少百分比；EWL：额外体质量减少百分比；-：文献未提及
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表 3 胃内球囊与减重手术比较
项目 胃内球囊 减重手术 适应证 (1)BMI 30~40 kg/m2，经严格的饮食生活方式或药物干预无效的人群；(2)BMI≥40 kg/m2，拒绝手术或有手术禁忌证的人群；(3)BMI≥50 kg/m2，减重手术术前进行先期诱导性减重治疗[7, 17-18] (1)BMI≥37.5 kg/m2的单纯肥胖患者，建议积极手术；(2)BMI 32.5~37.5 kg/m2，推荐手术；BMI 27.5~32.5 kg/m2，经改变生活方式和内科治疗难以控制，且至少符合2项代谢综合征组分或存在合并症[6] 主要并发症 胃肠道症状(91%)，球囊破裂和移位(0.6%~15%)，胃肠道梗阻(0.15%~2.9%)，胃溃疡(2.9%~3.33%)，消化道穿孔(0.05%~1.7%)，胰腺炎(2.1%)[9, 24-30, 40] 早期并发症，如消化道漏(0.7%~7.0%)、胃出血(0.7%~4.4%)、静脉血栓栓塞(0.3%~1.3%)、吻合口狭窄(3%~6%)、内疝与肠梗阻(1.3%~4.4%)；远期并发症，如吻合口溃疡(4.0%~7.0%)、倾倒综合征、胆管结石、营养不良、胃食管反流等[6] 治疗糖尿病 尚需验证 标准治疗 长期减重效果 尚需验证，球囊取出后长期随访研究较少：一项随访2年的研究显示患者减重和代谢获益并未维持[16]；另一项随访5年的研究发现，额外体质量减轻13.0%[34] 长期减重效果显著, 术后长期随访研究较多：一项随访10年得随机对照研究结果显示患者仍可减重28%[4] BMI: 体质量指数
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