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[治疗病态肥胖症两年随访后胆胰转流术伴或不伴胃切除术的比较]

[Comparision between a bilio-pacreatic diversion with or without gastroresection after 2 years of follow-up in the treatment of the pathological obesity].

作者信息

Mittempergher Francesco, Di Betta Ernesto, Nascimbeni Riccardo, Casella Claudio

机构信息

Cattedra di Chirurgia Generale, Università degli Studi di Brescia, 10 Divisione di Chirurgia Generale, Spedali Civili di Brescia.

出版信息

Ann Ital Chir. 2008 Jul-Aug;79(4):241-5.

Abstract

Malabsorptive bariatric procedures have a long history beginning with jejunoileal bypass, which was first performed in 1950s. The biliopancreatic diversion (BPD) has gained more prominence in Europe since its introduction by Scopinaro in 1976 The BPD has been modified and popularized by Hess in the United States and Marceau in Canada to include a sleeve gastrectomy and duodenal switch in order to decrease the incidence of marginal ulceration and iron deficiency anemia. Moreover the common channel was lengthened to 100 cm to decrease the incidence of long-term malnutrition. More recently Vassallo and coll. introduced a BPD associated with a transitory vertical gastroplasty (TGR). Aim of this study is to compare the results after 2 years follow-up in 15 obese patients who underwent the classical Scopinaro's BPD (group A) and 15 obese patients operated on BPD associated with TGR (group B).The mean preoperative BMI was 47.9 in the Group A and 48.6 in Group B. The BMI trend was after 6, 12 and 24 months: 39.1, 37.2, 33.1 in Group A and 37.3, 35.5, 31.4 in Group B. We observed in BPD+TGR one case of acute pancreatitis and 3 case of gastric paralysis in group A. No mortality was registered. Patients treated by BPD+TGR had better results in terms of weight loss and metabolic complications.

摘要

吸收不良型减肥手术有着悠久的历史,始于20世纪50年代首次开展的空肠回肠分流术。自1976年斯科皮纳罗引入胆胰分流术(BPD)以来,该手术在欧洲越来越受关注。在美国,赫斯对BPD进行了改良并推广,在加拿大,马尔索也对其进行了改良,改良后的手术包括袖状胃切除术和十二指肠转位术,以降低边缘性溃疡和缺铁性贫血的发生率。此外,将共同通道延长至100厘米,以降低长期营养不良的发生率。最近,瓦萨洛等人引入了一种与暂时性垂直胃成形术(TGR)相关的BPD。本研究的目的是比较15例接受经典斯科皮纳罗BPD手术的肥胖患者(A组)和15例接受与TGR相关的BPD手术的肥胖患者(B组)在2年随访后的结果。A组术前平均体重指数(BMI)为47.9,B组为48.6。术后6个月、12个月和24个月时的BMI变化趋势为:A组分别为39.1、37.2、33.1,B组分别为37.3、35.5、31.4。我们在A组中观察到1例急性胰腺炎和3例胃麻痹病例。无死亡病例记录。接受BPD+TGR治疗的患者在体重减轻和代谢并发症方面取得了更好的效果。

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