Murr M M, Balsiger B M, Kennedy F P, Mai J L, Sarr M G
Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
J Gastrointest Surg. 1999 Nov-Dec;3(6):607-12. doi: 10.1016/s1091-255x(99)80082-1.
The aim of this study was to determine the efficacy and safety of two malabsorptive procedures for severe obesity. Prospectively collected data from eight men and three women who underwent partial biliopancreatic bypass (PBB) and 19 men and seven women who underwent very very long limb Roux-en-Y gastric bypass (VVLGB) for superobesity (preoperative weight >225% above ideal body weight) were evaluated. Age (42 +/- 3 years and 40 +/- 2 years), body mass index (64 +/- 4 kg/m(2) and 67 +/- 3 kg/m(2)), and percentage of excess body weight (183% +/- 17% and 203% +/- 12%) were similar (mean +/- standard error of the mean). Median follow-up was 96 months (range 72 to 108 months) and 24 months (range 18 to 60 months) for the PBB and VVLGB groups, respectively. Weight loss expressed as percentage of excess body weight was 68% +/- 4% 2 years and 71% +/- 5% 4 years after PBB, and 53% +/- 7% 2 years and 57% +/- 5% 4 years after VVLGB. Current body mass indexes are 37 +/- 2 kg/m(2) and 42 +/- 2 kg/m(2) in the PBB and VVLGB groups, respectively. Hospital mortality was zero. Morbidity occurred in five patients after VVLGB (wound infection in four, wound seroma in one, and pulmonary embolus in one) and in two patients after PBB (abscess in two, anastomotic leak in one, and gastrointestinal bleeding in one). After PBB, one woman died of refractory liver failure 18 months postoperatively and two other patients developed metabolic bone disease. No such known complications have occurred to date after VVLGB. We conclude that VVLGB is safe and effective for clinically significant obesity, results in sustained weight loss, and improves quality of life.
本研究的目的是确定两种用于治疗重度肥胖的吸收不良手术的疗效和安全性。对前瞻性收集的8名男性和3名女性接受部分胆胰分流术（PBB）以及19名男性和7名女性接受极长肢Roux-en-Y胃旁路术（VVLGB）治疗极度肥胖（术前体重超过理想体重225%以上）的数据进行了评估。两组患者的年龄（分别为42±3岁和40±2岁）、体重指数（分别为64±4kg/m²和67±3kg/m²）以及超重百分比（分别为183%±17%和203%±12%）相似（均值±均值标准误差）。PBB组和VVLGB组的中位随访时间分别为96个月（范围72至108个月）和24个月（范围18至60个月）。以超重百分比表示的体重减轻情况为，PBB术后2年为68%±4%，4年为71%±5%；VVLGB术后2年为53%±7%，4年为57%±5%。PBB组和VVLGB组目前的体重指数分别为37±2kg/m²和42±2kg/m²。住院死亡率为零。VVLGB术后有5例患者出现并发症（4例伤口感染、1例伤口血清肿和1例肺栓塞），PBB术后有2例患者出现并发症（2例脓肿、1例吻合口漏和1例胃肠道出血）。PBB术后，1名女性在术后18个月死于难治性肝衰竭，另外2名患者出现代谢性骨病。VVLGB术后至今未发生此类已知并发症。我们得出结论，VVLGB对临床上显著肥胖患者安全有效，能实现持续体重减轻，并改善生活质量。
