Fewer Nutrient Deficiencies After Laparoscopic Sleeve Gastrectomy (LSG) than After Laparoscopic Roux-Y-Gastric Bypass (LRYGB)-a Prospective Study
Fewer Nutrient Deficiencies After Laparoscopic Sleeve Gastrectomy (LSG) than After Laparoscopic Roux-Y-Gastric Bypass (LRYGB)-a Prospective Study
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DOI：
10.1007/s11695-009-0068-4
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发表时间：
2010-04-01
期刊：
影响因子：
2.9
通讯作者：
Peterli, Ralph
中科院分区：
文献类型：
--
作者：
Gehrer, Simone;Kern, Beatrice;Peterli, Ralph
减肥手术后微量营养素缺乏是常见的，尽管常规补充。主要结果指标为术前和术后营养缺乏的发生率及其治疗成功率。在2004年5月至2006年12月期间，前瞻性分析了136例患者（男：女= 0：4），平均体重指数为45（35-58）kg/m2，年龄为53（21-66）岁。86例行腹腔镜Roux-Y胃旁路术（LRYGB），50例行腹腔镜袖状胃切除术（LSG）。使用标准方案（包括实验室检查）在术前以及术后3、6、12、24、30和36个月对患者进行检查。平均随访时间为24.4（12-40）个月，随访率为100%，57%的患者术前存在至少一种维生素D-3缺乏，其中23%存在维生素D-3缺乏。LSG后常见的术后缺乏症为锌、维生素D-3、叶酸、铁和维生素B-12; LRYGB后为维生素B-12、维生素D-3、锌和继发性甲状旁腺功能亢进。未发现维生素B-1或B-6缺乏，所有患者的钙水平均正常。这些缺陷的治疗大多是成功的，术前，57%的病态肥胖患者已经有缺陷。术后，在接受LRYGB的患者中发现明显更多的维生素B-12和维生素D缺乏症和甲状旁腺功能亢进。LSG后，叶酸缺乏症更频繁（但不显着）。所有患者的钙水平均正常;因此，甲状旁腺激素和维生素D-3水平是早期检测钙代谢紊乱的更敏感的标志物。缺铁性贫血最有效的治疗方法是静脉注射。
Deficiencies in micronutrients after bariatric operations are frequent, despite routine supplementation. Main outcome measures were pre- and postoperative frequency of nutrient deficiencies and success rate of their treatment.Between 5/2004 and 12/2006, 136 patients (m:f = 0:4) with an average body mass index of 45 (35-58) kg/m(2) and age of 53 (21-66) years were prospectively analysed. Laparoscopic Roux-Y-gastric bypass (LRYGB) was performed in 86 patients and laparoscopic sleeve gastrectomy (LSG) was performed in 50 patients. The patients were examined before surgery as well as 3, 6, 12, 24, 30, and 36 months postoperatively using a standard protocol including laboratory tests. The mean follow-up time was 24.4 (12-40) months; the follow-up rate was 100%.Prior to surgery, 57% of the patients had at least one deficiency, 23% of whom had vitamin D-3 deficiency. Frequent postoperative deficiencies after LSG were zinc, vitamin D-3, folic acid, iron, and vitamin B-12; after LRYGB, vitamin B-12, vitamin D-3, zinc, and secondary hyperparathyroidism. No vitamin B-1 or B-6 deficiencies were found. Calcium levels were normal in all patients. Treatment of the deficiencies was mostly successful.Preoperatively, 57% of morbidly obese patients already had a deficiency. Postoperatively, significantly more vitamin B-12 and vitamin D deficiencies and hyperparathyroidism were found in patients who had undergone LRYGB. After LSG, folate deficiency was more frequent (but not significantly so). Calcium levels were normal in all patients; therefore, parathyroid hormone and vitamin D-3 levels are more sensitive markers for early detection of disorders of calcium metabolism. Iron deficiency anaemia is most efficiently treated by IV therapy.