Laparoscopic Roux-en-Y gastric bypass surgery on morbidly obese patients with hypothyroidism
Laparoscopic Roux-en-Y gastric bypass surgery on morbidly obese patients with hypothyroidism
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DOI：
10.1007/s11695-007-9279-8
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发表时间：
2008-06-01
期刊：
影响因子：
2.9
通讯作者：
Merola, Stephen
中科院分区：
文献类型：
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作者：
Fazylov, Rafael;Soto, Eliana;Merola, Stephen
背景众所周知，肥胖伴随着甲状腺功能的改变。甲状腺功能减退症与体重增加有关。本研究的目的是评价手术结果、体重减轻、以及体重减轻对接受腹腔镜Roux-en-Y胃旁路术（LRYGB）的病态肥胖甲状腺功能减退症患者甲状腺功能的影响方法回顾性分析2003年1月至2006年8月期间接受LRYGB治疗的20例患有甲状腺功能减退症并接受甲状腺替代治疗的病态肥胖女性患者。术前体重指数（BMI）为47.6 kg/m2（范围38-58.5 kg/m2）。患者平均年龄为44.5岁（范围21-66岁）。有1例早期并发症（肺炎）。晚期并发症包括1例死亡、3例吻合口狭窄和1例小肠梗阻。患者平均随访13.5个月（范围3-24个月）。在1、3、6、9、12和24个月时，其平均超额体重减轻分别为13 kg（22%）、24.4 kg（39.4%）、33.2 kg（63.3%）、38.4 kg（65%）、41.7 kg（70%）和43 kg（73%）。无论患者术前和术后甲状腺素剂量如何，平均BMI的变化均相同。5例（25%）患者甲状腺功能减退消退，2例（10%）患者改善，8例（40%）患者无变化，5例（25%）患者恶化。甲状腺功能减退症恶化的五个甲状腺自身免疫性diseases.Conclusions甲状腺功能减退症似乎改善了绝大多数病态肥胖患者接受LRYGB，除了那些甲状腺疾病是自身免疫性的。
Background It is well known that obesity is accompanied by changes in thyroid function. Hypothyroidism is associated with increased body weight. The aim of this study was to evaluate the operative outcomes, weight loss, and the effect of weight loss on thyroid function in morbidly obese patients with hypothyroidism who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery.Methods A retrospective review of 20 morbidly obese female patients with hypothyroidism and on thyroid replacement therapy who underwent LRYGB between January 2003 and August 2006.Results Mean preoperative body mass index (BMI) was 47.6 kg/m(2) (range 38-58.5 kg/m(2)). Average patient age was 44.5 years (range 21-66 years). There was one early complication (pneumonia). Late complications included one death, three anastomotic strictures, and one small bowel obstruction. The patients were followed for a mean of 13.5 months (range 3-24 months). Their mean excess body weight loss was 13 kg (22%), 24.4 kg (39.4%), 33.2 kg (63.3%), 38.4 kg (65%), 41.7 kg (70%), and 43 kg (73%) at 1, 3, 6, 9, 12, and 24 months, respectively. Change in a mean BMI was the same regardless of the patient preoperative and postoperative thyroxine dose. Hypothyroidism resolved in 5(25%) patients, improved in 2(10%) patients, unchanged in 8(40%) patients, and worsened in 5 (25%) patients. Most of the five whose hypothyroidism worsened had thyroid autoimmune disease.Conclusions Hypothyroidism appears to improve in the vast majority of morbidly obese patients who undergo LRYGB, except for those whose thyroid disease is autoimmune in nature.