Malabsorptive gastric bypass in patients with superobesity
Malabsorptive gastric bypass in patients with superobesity
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超级肥胖症患者的吸收不良性胃旁路术
DOI：
10.1016/s1091-255x(01)00022-1
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发表时间：
2002-03-01
影响因子：
3.2
通讯作者：
Cody, RP
中科院分区：
文献类型：
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作者：
Brolin, RE;LaMarca, LB;Cody, RP
超肥胖患者在常规胃限制性手术（包括常规Roux-en-Y胃旁路术（RYGB））后体重减轻一直是个问题。本研究的目的是比较过度肥胖患者的体重减轻（体重指数大于或等于50 kg/m2），使用远端RYGB（D-RY），其中在回盲部近端75 cm处进行Roux-en-Y吻合术（N = 47），与Roux分支150 cm（N = 152）和50 - 75 cm（N = 99）的患者相比.所有手术均采用相同的胃限制性参数。最短随访时间为3年，范围为16年。5年内，D-RY组的体重减轻和体重指数降低显著大于RYGB-150 cm组和短RYGB组，RYGB-150 cm组显著大于短RYGB组。过量体重减轻的平均百分比在DRY后达到64%，在RYGB-150 cm后达到61%，在短RYGB后达到56%。维持5年的体重减轻与Roux肢体长度相关，D-RY大于RYGB-150 cm大于短RYGB。超过95%的肥胖相关共病症状随着体重减轻而改善或消退。术后早期发病率无差异：D-RY后9%; RYGB-150 cm后8%;短RYGB后2%，1例死亡（0.3%）。所有D-RY患者至少有一个术后代谢异常。D-RY与较短RYGB相比，D-RY后贫血明显更常见，RYGB-150 cm和短RYGB之间的代谢后遗症发生率无差异。没有手术因营养并发症而逆转或修改。2例D-RY患者因蛋白质营养不良需要全肠外营养。这些结果表明，Roux肢体长度与超肥胖患者的体重减轻相关。然而，D-RY与RYGB-150 cm相比，其代谢后遗症的发生率更高，这使得人们对其在接受减肥手术的超肥胖患者中的常规使用提出了质疑。我们的结论是，一定程度的吸收不良应纳入减肥手术进行超肥胖患者，以实现令人满意的长期减肥。
Weight loss in superobese patients has been problematic after conventional gastric restrictive operations including conventional Roux-en-Y gastric bypass (RYGB). The goal of the present study was to compare weight loss in patients with superobesity (body mass index greater than or equal to50 kg/m(2)) using a distal RYGB (D-RY) in which the Roux-en-Y anastomosis was performed 75 cm proximal to the ileocecal junction (N = 47) vs. patients who had Roux limbs of 150 cm (N = 152) and 50 to 75 cm (N = 99). All operations incorporated the same gastric restrictive parameters. Minimum follow-up was 3 years and ranged to 16 years. Weight loss and reduction in body mass index were significantly greater after D-RY vs. both RYGB-150 cm and short RYGB and in RYGB-150 cm vs. short RYGB through 5 years. Mean percentage of excess weight loss peaked at 64% after DRY, at 61% after RYGB-150 cm, and at 56% after short RYGB. Weight loss maintenance through 5 years was correlated with Roux limb length with D-RY greater than RYGB-150 cm greater than short RYGB. More than 95% of obesity-related comorbid conditions improved or resolved with weight loss. There was no difference in the early postoperative morbidity rates: 9% after D-RY; 8% after RYGB-150 cm; and 2% after short RYGB with one death (0.3%). All D-RY patients had at least one postoperative metabolic abnormality. Anemia was significantly more common after D-RY vs. the shorter RYGB with no difference in the incidence of metabolic sequelae between RYGB-150 cm and short RYGB. No operations were reversed or modified for nutritional complications. Two D-RY patients required total parenteral nutrition for protein malnutrition. These results show that Roux limb length is correlated with weight loss in superobese patients. However, the greater incidence of metabolic sequelae after D-RY vs. RYGB-150 cm calls into question its routine use in superobese patients undergoing bariatric surgery. We conclude that some degree of malabsorption should be incorporated into bariatric operations performed in superobese patients to achieve satisfactory long-term weight loss.