Greco Milena, De Micheli Enrico, Lonardo Amedeo
Unità Operativa di Medicina Interna e Gastroenterologia, Ospedale Civile di Modena.
Ann Ital Med Int. 2003 Apr-Jun;18(2):99-103.
The Scopinaro surgical technique for obesity consists of a partial distal gastrectomy with biliopancreatic diversion and cholecystectomy. It is an effective procedure in the control of the body weight but disrupts the physiological gut-liver axis. We report the case of a patient who developed liver cirrhosis with a multifactorial pathogenesis following antiobesity surgery according to Scopinaro and discuss the pathogenesis of the liver damage on the basis of our present understanding of alcoholic and nonalcoholic steatohepatitis. A 41-year-old male patient presented with ascites due to cryptogenic liver cirrhosis. Owing to morbid obesity, he had undergone antiobesity surgery according to Scopinaro when he was 25 years old. The procedure was effective and the patient lost about 40 kg of weight but manifested chronic diarrhea in the postoperative course. During the following 15 years, the patient continued to assume 100 g alcohol/day and did not turn up for clinical evaluation. Signs and symptoms of liver failure appeared in May 2000. After surgical correction of biliopancreatic diversion and abstinence from alcohol the hepatocellular function partially recovered and the patient regained his subjective complete well-being. The multifactorial pathogenesis of the liver disease observed in our patient included obesity, antrectomy, heavy alcohol consumption, bacterial overgrowth, and protein malnutrition.
斯科皮纳罗肥胖症手术技术包括部分远端胃切除术、胆胰转流术和胆囊切除术。这是一种控制体重的有效手术,但会破坏生理上的肠-肝轴。我们报告了一例患者,其按照斯科皮纳罗手术进行减肥手术后发生了具有多因素发病机制的肝硬化,并根据我们目前对酒精性和非酒精性脂肪性肝炎的理解讨论肝损伤的发病机制。一名41岁男性患者因隐源性肝硬化出现腹水。由于病态肥胖,他在25岁时接受了斯科皮纳罗减肥手术。该手术有效,患者体重减轻了约40公斤,但术后出现慢性腹泻。在接下来的15年里,患者继续每天摄入100克酒精,且未前来进行临床评估。2000年5月出现肝功能衰竭的体征和症状。在对胆胰转流术进行手术矫正并戒酒之后,肝细胞功能部分恢复,患者恢复了主观上的完全健康状态。在我们的患者中观察到的肝病多因素发病机制包括肥胖、胃窦切除术、大量饮酒、细菌过度生长和蛋白质营养不良。