Shiffman M L, Sugerman H J, Kellum J M, Brewer W H, Moore E W
Department of Medicine, Medical College of Virginia, Richmond.
Am J Gastroenterol. 1991 Aug;86(8):1000-5.
The present study evaluated the incidence of gallstone formation in 105 morbidly obese patients undergoing rapid weight loss after proximal gastric bypass surgery. Intraoperative ultrasonography demonstrated gallstones in 20 (19%) and gallbladder sludge in four (4%) patients. Eighty-one patients had a normal gallbladder ultrasound. After bariatric surgery, these patients were followed prospectively with periodic gallbladder ultrasound examinations. At 6 months, gallstones had developed in 36% and gallbladder sludge in 13% of patients. These percentages remained relatively constant at 12 and 18 months. Body weight declined rapidly after surgery from a mean of 132.3 kg to 95.5, 87.0, and 84.0 kg at 6, 12, and 18 months, respectively. Gallstones developed significantly more often in the white race, and in women. No significant differences in age, body weight, percent ideal body weight, percent weight loss, or percent of excess body weight lost existed between patients who developed gallstones or sludge and those who did not. Patients who developed gallbladder sludge had less cholesterol and lower cholesterol saturation (1.25 +/- 0.42) in their gallbladder bile than persons who developed gallstones (2.00 +/- 0.79). Forty percent (13/32) of patients who developed gallstones became symptomatic; nine (28%) underwent elective cholecystectomy. An attempt to prevent gallstone formation during rapid weight loss appears warranted.
本研究评估了105例接受近端胃旁路手术后快速减重的病态肥胖患者胆结石形成的发生率。术中超声检查发现20例（19%）患者有胆结石，4例（4%）患者有胆囊泥沙样沉积物。81例患者胆囊超声检查正常。减肥手术后，对这些患者进行前瞻性随访，定期进行胆囊超声检查。6个月时，36%的患者出现胆结石，13%的患者出现胆囊泥沙样沉积物。这些百分比在12个月和18个月时保持相对稳定。术后体重迅速下降，6个月、12个月和18个月时平均体重分别从132.3 kg降至95.5 kg、87.0 kg和84.0 kg。白种人和女性中胆结石的发生率明显更高。出现胆结石或胆囊泥沙样沉积物的患者与未出现的患者在年龄、体重、理想体重百分比、体重减轻百分比或多余体重减轻百分比方面没有显著差异。出现胆囊泥沙样沉积物的患者胆囊胆汁中的胆固醇含量较低，胆固醇饱和度也较低（1.25±0.42），而出现胆结石的患者为（2.00±0.79）。出现胆结石的患者中有40%（13/32）出现症状；9例（28%）接受了择期胆囊切除术。在快速减重期间尝试预防胆结石形成似乎是有必要的。
