Meinhardt Nelson Guardiola, Souto Kátia Elisabete Pires, Ulbrich-Kulczynski Jane Maria, Stein Airton Teitelbom
Class III Obesity Care Center, Porto Alegre, Brazil.
Obes Surg. 2006 Sep;16(9):1171-8. doi: 10.1381/096089206778392239.
One of the reasons why jejunoileal bypass (JIB) was abandoned were reports of liver failure. The aim of this study was to describe histological findings in the intraoperative and follow-up liver biopsies of a cohort of super-obese patients who had undergone JIB.
50 consecutive patients underwent JIB. Samples of liver biopsies performed intraoperatively (41 patients) and in the follow-up (31 patients) were evaluated. Brunt's scale was used.
Mean age at operation was 37.9 +/- 7.6 years, and 15 patients (30.6%) had diabetes type 2, 20 (40.8%) had dyslipidemia, 29 (59.2%) had high blood pressure, and one (0.5%) had hepatitis C. Mean BMI preoperatively was 52.8 +/- 7.5 kg/m(2). Mean follow-up time was 67.0 +/- 42.8 months. At the time of the latest liver biopsy, the mean BMI was 35.7 +/- 7.5 kg/m(2). The % excess weight loss (%EWL) was 62.4 +/- 20.0%. 8 deaths (16%) have occurred, none from liver-related complications. At liver biopsy during the JIB operation, NAFLD was confirmed in 36 patients (86.7%) and NASH in 13 (31.7%). In 25 patients with mean follow-up of 4.8 +/- 4.0 years, there was no statistically significant change in the liver histology regarding the extent of steatosis (P=0.20), steatohepatitis (P=0.74) and fibrosis (P=0.71).
There was a significant metabolic improvement, maintenance of the %EWL, and no worsening of liver histology. There has possibly been a publication bias concerning liver outcomes, where the type of JIB and the concomitance of hepatitis C were not taken into account.
空回肠分流术（JIB）被弃用的原因之一是有关于肝衰竭的报道。本研究的目的是描述一组接受JIB的超级肥胖患者术中及随访肝脏活检的组织学结果。
50例连续患者接受了JIB。对术中（41例患者）及随访时（31例患者）所取的肝脏活检样本进行评估。采用布伦特评分标准。
手术时的平均年龄为37.9±7.6岁，15例患者（30.6%）患有2型糖尿病，20例（40.8%）患有血脂异常，29例（59.2%）患有高血压，1例（0.5%）患有丙型肝炎。术前平均体重指数为52.8±7.5kg/m²。平均随访时间为67.0±42.8个月。在最近一次肝脏活检时，平均体重指数为35.7±7.5kg/m²。超重体重减轻百分比（%EWL）为62.4±20.0%。已发生8例死亡（16%），均非肝脏相关并发症所致。在JIB手术期间的肝脏活检中，36例患者（86.7%）确诊为非酒精性脂肪性肝病（NAFLD），13例（31.7%）确诊为非酒精性脂肪性肝炎（NASH）。在平均随访4.8±4.0年的25例患者中，肝脏组织学在脂肪变性程度（P=0.20）、脂肪性肝炎（P=0.74）和纤维化（P=0.71）方面无统计学显著变化。
有显著的代谢改善，%EWL得以维持，且肝脏组织学未恶化。关于肝脏结局可能存在发表偏倚，未考虑JIB的类型及丙型肝炎的合并情况。
