Hamoui Nahid, Anthone Gary J, Kaufman Howard S, Crookes Peter F
Department of Surgery, University of Southern California, Keck School of Medicine, 1510 San Pablo Street, Los Angeles, CA 90033, USA.
Surg Obes Relat Dis. 2008 May-Jun;4(3):404-6; discussion 406-7. doi: 10.1016/j.soard.2007.08.020. Epub 2007 Dec 11.
It is commonly believed that weight loss after biliopancreatic diversion/duodenal switch is inversely related to the length of the alimentary limb and the common channel. However, the effect of the biliopancreatic limb length (BPL) on weight loss has received little attention.
A total of 1001 patients after biliopancreatic diversion/duodenal switch (209 men and 792 women, mean age 42 +/- 10 yr, mean body mass index [BMI] 52 +/- 9 kg/m(2)) were divided into 2 groups according to the ratio of the BPL to the total small bowel length (SBL): a BPL < or =45% of the SBL versus a BPL >45% of the SBL. The nutritional parameters and percentage of excess weight loss were compared between the 2 groups.
In patients with a BMI of < or =60 kg/m(2), the percentage of excess weight loss at 1 year postoperatively was 66.8% for those with a BPL < or =45% of the SBL and 69.3% for those with a BPL >45% of the SBL (P = NS). At 2 years, the corresponding percentages were 73.7% and 79.5% (P = NS) and, at 3 years, were 73.4% and 75.2% (P = NS). In patients with a BMI >60 kg/m(2), the corresponding percentages of excess weight loss was 56.8% versus 61.4% (P = .07) at 1 year, 62.2% versus 77.5% (P = .04) at 2 years, and 59.8% versus 77.5% at 3 years (P = .05).
The results of our study have shown that amount of weight lost after biliopancreatic diversion/duodenal switch is directly related to the proportion of small bowel bypassed in patients with a BMI >60 kg/m(2). Also, the effect increased with the duration of follow-up. In less heavy patients, the BPL/SBL ratio had a minimal effect on long-term weight loss and a more pronounced effect on nutritional parameters.
人们普遍认为，胆胰转流/十二指肠转位术后的体重减轻与消化道支和共同通道的长度呈负相关。然而，胆胰支长度（BPL）对体重减轻的影响却很少受到关注。
总共1001例接受胆胰转流/十二指肠转位术的患者（209例男性和792例女性，平均年龄42±10岁，平均体重指数[BMI]52±9kg/m²）根据BPL与小肠总长度（SBL）的比例分为2组：BPL≤SBL的45%与BPL＞SBL的45%。比较两组之间的营养参数和超重减轻百分比。
BMI≤60kg/m²的患者中，BPL≤SBL的45%者术后1年超重减轻百分比为66.8%，BPL＞SBL的45%者为69.3%（P=无统计学意义）。2年时，相应百分比分别为73.7%和79.5%（P=无统计学意义），3年时分别为73.4%和75.2%（P=无统计学意义）。BMI＞60kg/m²的患者中，相应的超重减轻百分比在1年时为56.8%对61.4%（P=0.07），2年时为62.2%对77.5%（P=0.04），3年时为59.8%对77.5%（P=0.05）。
我们的研究结果表明，胆胰转流/十二指肠转位术后的体重减轻量与BMI＞60kg/m²患者中被旁路的小肠比例直接相关。而且，这种影响随着随访时间的延长而增加。在体重较轻的患者中，BPL/SBL比例对长期体重减轻影响最小，而对营养参数影响更显著。
