Artuso Dominick, Wayne Michael, Kaul Ashutosh, Bairamian Moses, Teixeira Julio, Cerabona Thomas
Department of Surgery, Dobbs Ferry Community Hospital, Dobbs Ferry, NY 10522, USA.
Obes Surg. 2004 Jun-Jul;14(6):750-4. doi: 10.1381/0960892041590764.
Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is an effective operation for morbidly obese patients who have failed conservative weight loss treatments. It is currently indicated for patients with BMI >40 kg/m2 or >35 with significant co-morbidities. Controversy exists whether there is an upper limit to BMI beyond which this operation should not be performed.
Between April 1999 and February 2001, 82 patients (19 male, 63 female) underwent LRYGBP. Average age was 43.6, and average BMI was 56 kg/m2. These patients were divided into those with BMI < 60 and those with BMI > or =60 kg/m2.
There were 61 patients with BMI < 60 and 21 patients with BMI > or =60. The groups were similar in age, gender, distribution or incidence of co-morbid conditions (diabetes, coronary artery disease, hypertension, sleep apnea, asthma) between the groups. The BMI > or =60 group had a significantly longer length of stay (6.6 days vs 5.3 days, P <0.05), and only 1 patient (BMI 85) developed an anastomotic leak and died. 2 patients in this group (BMI 62 and 73) developed small bowel obstruction requiring lysis of adhesions. 1 patient in the BMI < 60 group developed a gastrojejunal stricture requiring balloon dilatation.
While patients with a BMI > or =60 are at higher risk for postoperative complications, they are also at higher risk from continued extreme obesity. In our series, 85% of these patients had an uneventful postoperative course and began shedding excess weight. BMI > or =60 should not be a contraindication for LRYGBP.
腹腔镜Roux-en-Y胃旁路术（LRYGBP）是一种针对保守减肥治疗失败的病态肥胖患者的有效手术。目前，该手术适用于BMI>40kg/m²或BMI>35且伴有严重合并症的患者。对于BMI是否存在上限，超过此上限则不应进行该手术，目前仍存在争议。
在1999年4月至2001年2月期间，82例患者（19例男性，63例女性）接受了LRYGBP手术。平均年龄为43.6岁，平均BMI为56kg/m²。这些患者被分为BMI<60的患者和BMI≥60kg/m²的患者。
BMI<60的患者有61例，BMI≥60的患者有21例。两组在年龄、性别、合并症（糖尿病、冠状动脉疾病、高血压、睡眠呼吸暂停、哮喘）的分布或发生率方面相似。BMI≥60的组住院时间明显更长（6.6天对5.3天，P<0.05），只有1例患者（BMI 85）发生吻合口漏并死亡。该组中有2例患者（BMI 62和73）发生小肠梗阻，需要松解粘连。BMI<60的组中有1例患者发生胃空肠狭窄，需要球囊扩张。
虽然BMI≥60的患者术后并发症风险较高，但持续极度肥胖也使他们面临更高风险。在我们的系列研究中，这些患者中有85%术后过程顺利，并开始减轻多余体重。BMI≥60不应成为LRYGBP的禁忌证。
