Benfield J R, Greenway F L, Bray G A, Barry R E, Lechago J, Mena I, Schedewie H
Surg Gynecol Obstet. 1976 Sep;143(3):401-10.
Fifty-eight patients less than 30 years old but who are more than 300 pounds in weight were considered for investigation of jejunoileal bypass. Thirty patients had operations, and the functioning bypass included 40 centimeters of jejunum and 10 centimeters of ileum. In 14 patients, intestinal continuity was restored by either end-to-end or end-to-side anastomosis according to random choice, and in 16 patients, end-to-end anastomoses were used. At present, the follow-up period is one to four years, and the weight loss, so far, has not been significantly related to the type of reconstruction used. Weight loss correlated possitively with the preoperative weights up to one year after operation. Also, weight loss correlated positively with the total measured length of the small intestine during the first six postoperative months, but this correlation currently is showing a trend toward negativity. Food intake decreased by 2,682+/-690 calories per day at six months after operation as a result of the bypass. Chronic acidosis was common. Results of an endocrine evaluation revealed an unexpected significant decrease in parathormone levels within the normal range. A new complication, colonic pseudo-obstruction, has occurred one year or more after operation in five patients or 17 per cent of our group. This complication is related to the intestinal anaerobic flora in proximity of the defunctionalized limb; its symptoms and signs can be alleviated by giving antibiotics or Lactobacillus to change the intestinal flora. Although 90 per cent of our patients are pleased with their progress and the results of routine evaluation corroborate their satisfaction, detailed analysis of the research data available to us revealed that only 43 per cent have had beneficial effects from a jejunoileal bypass without any of the serious sequelae. We consider jejunoileal bypass for obesity justified when carried out by interdisciplinary groups dedicated to the long term follow-up study of the patient and periodic reporting of the results. The long term future for the operation is, as yet, not completely understood, and when the conditions we have recommended are not present, we cannot currently endorse the operation.
对58例年龄小于30岁但体重超过300磅的患者进行了空回肠旁路手术的研究。30例患者接受了手术，功能性旁路包括40厘米空肠和10厘米回肠。14例患者根据随机选择通过端端或端侧吻合恢复肠道连续性，16例患者采用端端吻合。目前，随访期为1至4年，到目前为止，体重减轻与所采用的重建类型没有显著关系。术后一年内体重减轻与术前体重呈正相关。此外，术后前六个月体重减轻与小肠总测量长度呈正相关，但目前这种相关性呈下降趋势。由于旁路手术，术后六个月时每日食物摄入量减少2682±690卡路里。慢性酸中毒很常见。内分泌评估结果显示，甲状旁腺激素水平在正常范围内意外显著下降。一种新的并发症，结肠假性梗阻，在术后一年或更长时间发生在5例患者身上，占我们组的17%。这种并发症与失功能肠段附近的肠道厌氧菌丛有关；通过给予抗生素或乳酸杆菌改变肠道菌群，其症状和体征可以得到缓解。尽管我们90%的患者对他们的进展感到满意，常规评估结果也证实了他们的满意度，但对我们现有研究数据的详细分析显示，只有43%的患者从空回肠旁路手术中获得了有益效果，且没有任何严重后遗症。我们认为，当由致力于对患者进行长期随访研究并定期报告结果的跨学科团队进行空回肠旁路手术治疗肥胖症时是合理的。该手术的长期前景尚未完全明了，当我们推荐的条件不存在时，目前我们不能认可该手术。
