PARTIAL ILEAL BYPASS FOR HYPERCHOLESTEROLEMIA - 20-YEAR TO 26-YEAR FOLLOW-UP OF THE 1ST 57 CONSECUTIVE CASES
PARTIAL ILEAL BYPASS FOR HYPERCHOLESTEROLEMIA - 20-YEAR TO 26-YEAR FOLLOW-UP OF THE 1ST 57 CONSECUTIVE CASES
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DOI：
10.1097/00000658-199009000-00010
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发表时间：
1990-09-01
影响因子：
9
通讯作者：
VARCO, RL
中科院分区：
文献类型：
--
作者：
BUCHWALD, H;STOLLER, DK;VARCO, RL
1963 年至 1968 年间，明尼苏达大学有 57 名患者因原发性高胆固醇血症接受了部分回肠绕道术 (PIB)。这些患者的术前总血浆胆固醇 (TC) 为 363.3+ 136.8 mg/dL（平均值+ SD）。基线和后续 TC 结果显示，TC 降低非常显着 (p+/-0.001)，在 1、2 至 5、6 至 10、11 至 15 以及超过 20 时，TC 降低了 34%(n= 48)、28%(n= 49)、35%(n= 26)、35%(n= 11) 和 30%(n= 25) PIB 之后分别年。在 21 名具有基线、1 年和 20 年以上结果的患者中，TC 在 1 年时下降了 33%，并且在术后 20 年以上仍比基线低 29%（p= NS 与 1 年相比）。少数患者可获得血浆甘油三酯结果，并且 PIB 后没有出现统计学上的显着变化。两名患者（3.5%）接受了 PIB 逆转，其中一名患者治疗顽固性腹泻，另一名患者治疗复发性肾结石。在 25 名未逆转的长期幸存者中，没有发现统计学上显着的体重变化。 24% 的人每天排便次数为 0 到 2 次，52% 的人每天排便次数为 3 到 5 次，24% 的人每天排便次数超过 5 次。 8 名患者随后需要接受胆囊切除术，10 名患者（40%）出现肾结石。在 20 至 26 年期间，大多数幸存者出现临床上明显的动脉粥样硬化：心绞痛 (60%)、心肌梗死 (16%) 或冠状动脉搭桥术 (28%)。冠心病是非幸存者的主要原因（80%）。 PIB 后 1 年、5 年、10 年、15 年、20 年和 25 年的总生存率分别为 95%、88%、75%、59%、53% 和 41%。部分回肠绕道术导致 TC 显着降低，并且在术后 20 多年里这种情况一直持续，基本没有变化。与现有的流行病学和临床试验数据相比，这些结果支持了这样的假设：减少 TC 对高胆固醇血症患者有益。
Between 1963 and 1968, 57 patients underwent partial ileal bypass (PIB) at the University of Minnesota for primary hypercholesterolemia. Preoperative total plasma cholesterol (TC) was 363.3+ 136.8 mg/dL (mean+ SD) in these patients. Baseline and follow-up TC results demonstrated highly significant (p+/-0.001) TC reduction, 34%(n= 48), 28%(n= 49), 35%(n= 26), 35%(n= 11), and 30%(n= 25) at 1, 2 to 5, 6 to 10, 11 to 15, and more than 20 years, respectively, after PIB. In 21 patients with baseline, 1-year, and more than 20-year results, TC decreased 33% by 1 year and remained 29% less than baseline more than 20 years after surgery (p= NS versus 1 year). Plasma triglyceride results were available in fewer patients, and no statistically significant changes developed after PIB. Two patients (3.5%) underwent PIB reversal, one for intractable diarrhea and one for recurrent nephrolithiasis. In the 25 nonreversed, longterm survivors, no statistically significant weight change was noted. Twenty-four per cent had 0 to 2, 52% had 3 to 5, and 24% had more than 5 bowel movements per day. Subsequent cholecystectomy was required in eight patients, and nephrolithiasis developed in 10 (40%). During 20 to 26 years, most survivors developed clinically apparent atherosclerosis: angina (60%), myocardial infarction (16%), or coronary artery bypass (28%). Coronary heart disease was the predominant cause of death among nonsurvivors (80%). Overall survival rates were 95%, 88%, 75%, 59%, 53%, and 41% at 1, 5, 10, 15, 20, and 25 years, respectively, after PIB. Partial ileal bypass leads to highly significant TC reduction, which is sustained, essentially unchanged, more than 20 years after operation. In comparison to available epidemiologic and clinical trial data, these results support the hypothesis that TC reduction has a beneficial effect in patients with hypercholesterolemia.