Avgerinos Dimitrios V, Leitman I Michael, Martínez Ramon E, Liao E Pauline
Department of Surgery, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
J Am Coll Surg. 2007 Aug;205(2):294-7. doi: 10.1016/j.jamcollsurg.2007.02.078.
Gastric bypass operation has become a very common procedure for treatment of obesity. Changes in calcium absorption can result in changes in total body calcium, parathyroid hormone (PTH), and vitamin D levels. There is little known about the longterm effects of Roux-en-Y gastric bypass on calcium metabolism and bone homeostasis.
Between January 2000 and January 2006, 535 morbidly obese patients underwent standard Roux-en-Y gastric bypass. All patients were given a standard multivitamin, vitamin D, and calcium supplement starting on day 12 after the operation. Metabolic parameters, such as serum calcium levels, vitamin D, and PTH, both pre- and postoperatively, were measured and compared at several intervals.
Four-hundred and forty-four patients were followed for a minimum of 2 years. No statistical significance was found between the pre- and postoperative serum levels of calcium and vitamin D, although vitamin D levels generally increased during the first year after operation. Serum levels of PTH were substantially higher at 18 and 44 weeks after the operation.
Hypocalcemia did not develop in any patients during the postoperative period. Increased PTH levels were observed after gastric bypass operation. This can result in calcium mobilization of calcium from the skeleton and increased renal calcium reabsorption. Total body calcium depletion could occur from bone mobilization, if longterm calcium supplementation is not maintained. Vitamin D supplementation can assist in prevention of bone calcium depletion.
胃旁路手术已成为治疗肥胖症的一种非常常见的手术方法。钙吸收的变化会导致全身钙、甲状旁腺激素（PTH）和维生素D水平的变化。关于Roux-en-Y胃旁路手术对钙代谢和骨稳态的长期影响知之甚少。
在2000年1月至2006年1月期间，535例病态肥胖患者接受了标准的Roux-en-Y胃旁路手术。所有患者在术后第12天开始接受标准的多种维生素、维生素D和钙补充剂。在几个时间间隔测量并比较术前和术后的代谢参数，如血清钙水平、维生素D和PTH。
444例患者至少随访了2年。术前和术后血清钙和维生素D水平之间未发现统计学差异，尽管维生素D水平在术后第一年通常会升高。术后18周和44周时PTH的血清水平显著更高。
术后期间没有任何患者发生低钙血症。胃旁路手术后观察到PTH水平升高。这可能导致骨骼中的钙动员以及肾钙重吸收增加。如果不长期维持钙补充，骨骼动员可能会导致全身钙消耗。补充维生素D有助于预防骨钙消耗。
