Pigeyre M, Seguy D, Arnalsteen L, Pattou F, Romon M
Service de Nutrition, Faculté de Médecine, Pôle Recherche, Hôpital Claude Huriez, CHRU Lille, France.
Obes Surg. 2008 Sep;18(9):1203-7. doi: 10.1007/s11695-008-9467-1. Epub 2008 May 6.
The laparoscopic Roux-en-Y gastric bypass (LRYGBP) is increasingly popular for the treatment of morbid obesity, although its postsurgical complications are often underestimated. We report the case of a 22-year-old morbidly obese woman who underwent a LRYGBP, which was rapidly complicated by portal venous thrombosis and severe neurological complications due to vitamin deficiencies. She presented rapid body weight loss with optic and peripheral neuropathy. Clinical chemistry results showed low transthyretin and micronutrient levels. Intravenous micronutrient infusion and cyclic nocturnal enteral tube feeding were needed to slowly improve gait and visual acuity. We then discuss (1) factors that could have contributed to the nutritional deficiencies and (2) the preventive management of these types of nutritional complications. Gastric bypass procedures can cause multivitamin deficiencies. In the case presented here, complications occurred very soon after surgery. The increasing incidence of obesity and bariatric surgery warrants better patient education concerning strict adherence to vitamin supplementation.
腹腔镜Roux-en-Y胃旁路术（LRYGBP）在治疗病态肥胖方面越来越受欢迎，尽管其术后并发症常常被低估。我们报告一例22岁病态肥胖女性患者，她接受了LRYGBP手术，术后迅速出现门静脉血栓形成以及因维生素缺乏导致的严重神经并发症。她出现了体重快速下降，并伴有视神经和周围神经病变。临床化学检查结果显示转甲状腺素蛋白和微量营养素水平较低。需要静脉输注微量营养素并进行夜间周期性肠内管饲，以缓慢改善步态和视力。然后我们讨论了（1）可能导致营养缺乏的因素，以及（2）这些类型营养并发症的预防性管理。胃旁路手术可导致多种维生素缺乏。在本文所述病例中，并发症在手术后很快就出现了。肥胖症和减肥手术发病率的上升，使得有必要对患者进行更好的教育，使其严格坚持补充维生素。
