de Oliveira Leonardo Dornas, Diniz Marco Túlio C, de Fátima H S Diniz Maria, Savassi-Rocha Alexandre L, Camargos Sarah T, Cardoso Francisco
Neurology Service, Internal Medicine Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Obes Surg. 2009 Aug;19(8):1102-7. doi: 10.1007/s11695-008-9780-8. Epub 2008 Dec 19.
Obesity is a worldwide epidemic associated to comorbidities and increased mortality. Because it is chronic and recurrent and has little response to clinical measures, surgical treatment (bariatric surgery) is a therapeutic option frequently used. Different surgical complications have been associated with this type of procedure, but there is little knowledge about neuromuscular complications. Among the latter, rhabdomyolysis (RML), described a few years ago, has not been well characterized to date.
We have studied 22 consecutive patients who underwent surgical treatment with open Roux-en-Y gastric bypass (RYGBP) for morbid obesity in a university hospital. A database was created including the following information of each patient: gender, age, body mass index (BMI), comorbidities, surgical time, pre- and postoperative creatine phosphokinase (CPK) dosages, and neuromuscular symptoms after surgery. The main outcome measure was the frequency of RML using CPK dosage after 24 h of surgery. RML was diagnosed as an increase of more than five times the superior limit of normal range of CPK.
Fourteen women and eight men were evaluated, with median age of 39.9+/-11.2 years, median BMI of 52.4+/-8.0 kg/m2 and mean surgical time of 253.2+/-51.9 min. The mean value of postoperative CPK was 7,467.7+/-12,177.1 IU/L, being greater than 5,000 IU/L in 40.9% of the patients. RML was diagnosed in 17 (77.3%) patients. No patient had renal failure caused by RML, but there was one death (4.5%) related to abdominal infectious complications. Clinical neuromuscular symptoms occurred in 45% of patients, and muscular pain was the most common one, especially in gluteus region. Comparative analyzes between patients without and with RML diagnosis showed that longer surgical time (p=0.005), and occurrence of neuromuscular symptoms (p=0.04) were more common in the latter.
The results of this study are similar to few other investigations and confirm that RML in open bariatric surgery with RYGBP (Capella) is a common complication. A longer surgical time can be involved in RML pathogenesis, and muscular pain is suggestive of RML occurrence.
肥胖是一种全球性的流行病，与多种合并症及死亡率增加相关。由于其具有慢性、复发性且对临床措施反应甚微的特点，手术治疗（减重手术）成为常用的治疗选择。不同的手术并发症与这类手术相关，但对于神经肌肉并发症的了解甚少。在后者中，几年前描述的横纹肌溶解症（RML）至今尚未得到充分的特征描述。
我们研究了一家大学医院中连续接受开放式Roux-en-Y胃旁路术（RYGBP）治疗病态肥胖的22例患者。创建了一个数据库，其中包含每位患者的以下信息：性别、年龄、体重指数（BMI）、合并症、手术时间、术前和术后肌酸磷酸激酶（CPK）剂量以及术后神经肌肉症状。主要结局指标是术后24小时使用CPK剂量评估RML的发生率。RML被诊断为CPK超过正常范围上限五倍以上的升高。
共评估了14名女性和8名男性，中位年龄为39.9±11.2岁，中位BMI为52.4±8.0kg/m²，平均手术时间为253.2±51.9分钟。术后CPK的平均值为7467.7±12177.1IU/L，40.9%的患者CPK大于5000IU/L。17例（77.3%）患者被诊断为RML。没有患者因RML导致肾衰竭，但有1例（4.5%）死亡与腹部感染并发症相关。45%的患者出现临床神经肌肉症状，肌肉疼痛最为常见，尤其是在臀肌区域。对未诊断和诊断为RML的患者进行的比较分析表明，手术时间较长（p = 0.005）以及出现神经肌肉症状（p = 0.04）在后者中更为常见。
本研究结果与其他少数研究相似，证实了采用RYGBP（卡佩拉）的开放式减重手术中的RML是一种常见并发症。较长的手术时间可能与RML的发病机制有关，肌肉疼痛提示RML的发生。
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