BILIOPANCREATIC DIVERSION WITH A NEW-TYPE OF GASTRECTOMY - SOME PREVIOUS CONCLUSIONS REVISITED
BILIOPANCREATIC DIVERSION WITH A NEW-TYPE OF GASTRECTOMY - SOME PREVIOUS CONCLUSIONS REVISITED
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DOI：
10.1381/096089295765557511
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发表时间：
1995-11-01
期刊：
影响因子：
2.9
通讯作者：
BIRON, S
中科院分区：
文献类型：
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作者：
LAGACE, M;MARCEAU, P;BIRON, S
背景：1990年，我们修改了Scopinaro的胆胰分流术（BPD）；不是远端胃切除术和胃回肠吻合术，而是进行壁胃切除术，营养物质通过十二指肠开关转移。此外，公共通道的长度（50 厘米）加倍至 100 厘米，而营养管仍为 250 厘米。 1991 年，我们在 16 个月后报告了初步结果：BPD 后体重减轻符合预期，但患者报告的副作用较少，过度吸收不良的发生率也较低。这组患者的十二指肠被缝合以构建十二指肠开关。这种钉线在某些患者身上不知不觉地失败了，导致十二指肠部分或完全再通。这导致了不完全的 BPD。方法：自 1992 年以来，十二指肠开关已通过十二指肠的完全横断来构建，以防止再通。我们在这里报告了接受这一明确手术的前 61 名患者。结果：16 个月时，我们观察到平均体重减轻了最初超重的 84%，每日大便次数为 2.9 +/- 1.6 次，腹泻患病率为 10%。 20% 的患者出现轻度贫血、低钙血症或低蛋白血症，需要额外补充补充剂。 结论：BPD 联合壁胃切除术、十二指肠转位术和更长的共同通道可改善体重减轻并减少胃肠道副作用，同时不会增加过度吸收不良的发生率。壁胃切除术可能通过增加饱腹感来减轻体重，并通过调节胃排空来减少副作用。
Background: In 1990, we modified Scopinaro's biliopancreatic diversion (BPD); instead of a distal gastrectomy and gastroileal anastomosis, a parietal gastrectomy was performed with nutrients diverted through a duodenal switch. Also, the length of the common channel (50 cm) was doubled to 100 cm, while the nutrient limb remained 250 cm. In 1991, we reported initial results after 16 months: weight loss was as expected following BPD, but patients reported fewer side-effects and the prevalence of excessive malabsorption was less. This cohort of patients had their duodenum stapled shut to construct the duodenal switch. This staple-line failed insidiously in some patients, allowing the duodenum to recanalize partially or completely. This resulted in an incomplete BPD.Methods: Since 1992, the duodenal switch has been constructed with a complete transection of the duodenum to prevent recanalization. We report here on the first 61 patients who underwent this definitive procedure.Results: At 16 months, we observed a mean weight loss of 84% of initial excess weight, the number of daily stools at 2.9 +/- 1.6 and the prevalence of diarrhea at 10%. Twenty per cent of patients experienced mild anaemia, hypocalcemia, or hypoalbuminemia, which required added supplements.Conclusions: BPD with parietal gastrectomy, duodenal switch and longer common channel improved weight loss and decreased gastrointestinal side-effects without an increased prevalence of excessive malabsorption. The parietal gastrectomy may contribute to weight loss by increasing satiety, and decreasing side-effects by regulating gastric emptying.