Vanek Vincent W, Catania Michele, Triveri Kimberly, Woodruff Robert W
St. Elizabeth and St. Joseph Surgical Weight Loss Center, Youngstown, 44501, USA.
Surg Obes Relat Dis. 2006 Jan-Feb;2(1):17-22; discussioon 22-3. doi: 10.1016/j.soard.2005.10.004.
The purpose of this study was to analyze the frequency and results of preoperative biliary and gastrointestinal (GI) evaluation of patients undergoing Roux-en-Y gastric bypass (RYGB).
Retrospective review of the preoperative evaluation of 144 consecutive RYGB patients.
Cholecystectomy had already been performed in 43 (30%) patients; 22% of those patients with an intact gallbladder had cholelithiasis. Ten patients (7%) had an upper GI x-ray (UGI), and 94 patients (65%) had an esophagogastroduodenoscopy (EGD). Abnormalities were found in 40% of the UGIs and 84% of the EGDs. A total of 96 patients (67%) were tested for Helicobacter pylori; 11% were positive. Twenty-one patients (15%) underwent preoperative colonoscopy; 48% were abnormal, but most of the abnormalities were not clinically significant. Three patients had barium enema x-ray, which was normal in all cases.
The preoperative biliary and GI evaluation of bariatric surgery patients should include a routine ultrasound of the gallbladder. Routine preoperative EGD will detect a significant number of abnormalities that should be treated, but should rarely alter the bariatric surgical procedure or result in denial of bariatric surgery. Many abnormalities will be asymptomatic. Patients should be routinely screened for H. pylori and, if positive, treated before bariatric surgery. Lower GI evaluation should be performed selectively based on the patient's symptoms, physical findings, and guidelines for colorectal cancer and polyp screening.
本研究的目的是分析接受Roux-en-Y胃旁路术（RYGB）患者术前胆道和胃肠道（GI）评估的频率及结果。
回顾性分析144例连续接受RYGB患者的术前评估情况。
43例（30%）患者已行胆囊切除术；胆囊完整的患者中22%有胆结石。10例（7%）患者进行了上消化道X线检查（UGI），94例（65%）患者进行了食管胃十二指肠镜检查（EGD）。UGI检查中40%发现异常，EGD检查中84%发现异常。共96例（67%）患者检测了幽门螺杆菌；11%呈阳性。21例（15%）患者接受了术前结肠镜检查；48%存在异常，但大多数异常无临床意义。3例患者进行了钡剂灌肠X线检查，所有病例均正常。
肥胖症手术患者的术前胆道和GI评估应包括胆囊常规超声检查。常规术前EGD将检测到大量应治疗的异常情况，但很少会改变肥胖症手术程序或导致肥胖症手术被拒绝。许多异常将无症状。患者应常规筛查幽门螺杆菌，若呈阳性，在肥胖症手术前进行治疗。应根据患者症状、体格检查结果以及结直肠癌和息肉筛查指南选择性地进行下消化道评估。
