Guedea Manuela Elía, Arribas del Amo Dolores, Solanas Jose Antonio Gracia, Marco Consuelo Artigas, Bernadó Alfredo Jiménez, Rodrigo Miguel Angel Bielsa, Diago Vicente Aguilella, Díez Mariano Martínez
Department of Surgery, Clínico Universitario Lozano Blesa, San Juan Bosco, 5006 Zaragoza, Spain.
Obes Surg. 2004 Jun-Jul;14(6):766-72. doi: 10.1381/0960892041590809.
Gastric restrictive procedures, currently the most popular surgical operations for morbid obesity, have proved to be effective in initiating weight loss, but questions regarding their long-term efficacy in weight maintenance have arisen. Biliopancreatic diversion (BPD) is a mixed and complex technique that has shown good long-term results. There are no series with long-term follow-up of BPD in Spain. We present >5 year results (average 67.9 +/- 15 SD mons, range 48-96), evaluating weight loss, morbidity and mortality after BPD.
74 patients who underwent BPD and completed 5 or more years of follow-up were studied. The results have been analyzed in terms of weight loss (classification of Reinhold), improvement in morbidity, and improvement in quality of life (BAROS).
78.6% were women. Mean age was 38 +/- 11 years (18-61). Mean preoperative body mass index (BMI) was 54 +/- 8 kg/m(2). Progression of BMI: 1 year 34 +/- 6, 2 years 31 +/- 6, 5 years 33 +/- 7 and 7 years 31 +/- 3 kg/m(2). Excess weight loss at 1 year follow-up was 67%, at 2 years 75%, at 5 years 70% and at 7 years 71%. There were significant differences between morbidly obese (BMI <50 kg/m(2)) and super-obese (BMI >50 kg/m(2) ), with better results in the morbidly obese group.
BPD shows long-term effectiveness in weight loss, co-morbidity improvement and quality of life. Protein, vitamin and oligoelement deficits may appear in the long-term, so that strict follow-up and supplementation of deficiencies are necessary.
胃限制性手术是目前治疗病态肥胖最常用的外科手术，已被证明在启动体重减轻方面有效，但关于其在维持体重方面的长期疗效问题已经出现。胆胰转流术（BPD）是一种混合且复杂的技术，已显示出良好的长期效果。西班牙尚无关于BPD的长期随访系列研究。我们呈现了超过5年的结果（平均67.9±15标准差月，范围48 - 96个月），评估了BPD术后的体重减轻、发病率和死亡率。
研究了74例行BPD且完成5年或更长时间随访的患者。已根据体重减轻（莱因霍尔德分类法）、发病率改善情况和生活质量改善情况（巴罗斯法）对结果进行了分析。
78.6%为女性。平均年龄为38±11岁（18 - 61岁）。术前平均体重指数（BMI）为54±8kg/m²。BMI进展情况：1年时为34±6，2年时为31±6，5年时为33±7，7年时为31±3kg/m²。1年随访时多余体重减轻67%，2年时为75%，5年时为70%，7年时为71%。病态肥胖（BMI＜50kg/m²）和超级肥胖（BMI＞50kg/m²）之间存在显著差异，病态肥胖组效果更好。
BPD在体重减轻、合并症改善和生活质量方面显示出长期有效性。长期可能会出现蛋白质、维生素和微量元素缺乏，因此严格的随访和补充缺乏物质是必要的。
