Hatizifotis Michael, Dolan Kevin, Newbury Leanne, Fielding George
Department of Surgery, Royal Brisbane Hospital, Herston, Queensland, Australia.
Obes Surg. 2003 Aug;13(4):655-7. doi: 10.1381/096089203322190916.
Biliopancreatic diversion (BPD) is an effective operation for morbid obesity. Fat-soluble vitamin deficiencies are known complications of this procedure, with incidence rates reported as high as 6%.
A-36-year old morbidly obese female with BMI 60.6 kg/m(2) underwent laparoscopic adjustable gastric banding, followed 2 years later by BPD in an attempt to control her weight. Following BPD, she failed to attend outpatient appointments and was poorly compliant with daily multivitamins and monitoring of serum vitamin and mineral levels. She developed symptomatic vitamin A deficiency, with vitamin A levels <0.1 micromol/L, and night blindness, as well as deficiencies of vitamins D, E and K, zinc and selenium. Her vitamin deficiencies were corrected with appropriate supplements and her night blindness resolved.
This case raises the issues of preoperative screening of patients and compliance, as well as life-long postoperative monitoring of serum vitamin and mineral levels. With better compliance with outpatient appointments, prescribed multivitamins and oral vitamin A tablets, as well as regular monitoring of serum vitamin and mineral levels, vitamin deficiencies and their consequences, such as night blindness, may be avoided.
胆胰转流术（BPD）是治疗病态肥胖的一种有效手术。脂溶性维生素缺乏是该手术已知的并发症，报道的发生率高达6%。
一名36岁的病态肥胖女性，体重指数（BMI）为60.6kg/m²，接受了腹腔镜可调节胃束带术，2年后又接受了胆胰转流术以控制体重。胆胰转流术后，她未按预约就诊，也未严格遵医嘱每日服用多种维生素以及监测血清维生素和矿物质水平。她出现了有症状的维生素A缺乏，维生素A水平<0.1微摩尔/升，还有夜盲症，以及维生素D、E和K、锌和硒缺乏。通过适当补充，她的维生素缺乏得到纠正，夜盲症也得以缓解。
该病例提出了患者术前筛查和依从性问题，以及术后对血清维生素和矿物质水平进行终身监测的问题。通过更好地遵守门诊预约、按医嘱服用多种维生素和口服维生素A片，以及定期监测血清维生素和矿物质水平，可以避免维生素缺乏及其后果，如夜盲症。
