Department of Surgery, St. Claraspital, Kleinriehenstrasse 30, Basel, Switzerland.
Obes Surg. 2010 Apr;20(4):447-53. doi: 10.1007/s11695-009-0068-4. Epub 2010 Jan 26.
Deficiencies in micronutrients after bariatric operations are frequent, despite routine supplementation. Main outcome measures were pre- and postoperative frequency of nutrient deficiencies and success rate of their treatment.
Between 5/2004 and 12/2006, 136 patients (m:f = 0:4) with an average body mass index of 45 (35-58) kg/m(2) and age of 53 (21-66) years were prospectively analysed. Laparoscopic Roux-Y-gastric bypass (LRYGB) was performed in 86 patients and laparoscopic sleeve gastrectomy (LSG) was performed in 50 patients. The patients were examined before surgery as well as 3, 6, 12, 24, 30, and 36 months postoperatively using a standard protocol including laboratory tests. The mean follow-up time was 24.4 (12-40) months; the follow-up rate was 100%.
Prior to surgery, 57% of the patients had at least one deficiency, 23% of whom had vitamin D(3) deficiency. Frequent postoperative deficiencies after LSG were zinc, vitamin D(3), folic acid, iron, and vitamin B(12); after LRYGB, vitamin B(12), vitamin D(3), zinc, and secondary hyperparathyroidism. No vitamin B(1) or B(6) deficiencies were found. Calcium levels were normal in all patients. Treatment of the deficiencies was mostly successful.
Preoperatively, 57% of morbidly obese patients already had a deficiency. Postoperatively, significantly more vitamin B(12) and vitamin D deficiencies and hyperparathyroidism were found in patients who had undergone LRYGB. After LSG, folate deficiency was more frequent (but not significantly so). Calcium levels were normal in all patients; therefore, parathyroid hormone and vitamin D(3) levels are more sensitive markers for early detection of disorders of calcium metabolism. Iron deficiency anaemia is most efficiently treated by IV therapy.
尽管常规补充，但减重手术后仍常出现微量营养素缺乏。主要观察指标为术前和术后营养素缺乏的频率以及治疗的成功率。
2004 年 5 月至 2006 年 12 月，前瞻性分析了 136 例患者（男：女=0：4），平均体重指数为 45（35-58）kg/m²，年龄 53（21-66）岁。86 例行腹腔镜 Roux-Y 胃旁路术（LRYGB），50 例行腹腔镜袖状胃切除术（LSG）。患者术前以及术后 3、6、12、24、30 和 36 个月使用标准方案（包括实验室检查）进行检查。平均随访时间为 24.4（12-40）个月，随访率为 100%。
术前，57%的患者至少有一种缺乏，其中 23%的患者维生素 D3 缺乏。LSG 后常见的术后缺乏是锌、维生素 D3、叶酸、铁和维生素 B12；LRYGB 后常见的是维生素 B12、维生素 D3、锌和继发性甲状旁腺功能亢进症。未发现维生素 B1 或 B6 缺乏。所有患者的钙水平均正常。大多数缺乏症的治疗均取得成功。
术前，57%的病态肥胖患者已有缺乏。术后，行 LRYGB 的患者中，维生素 B12 和维生素 D 缺乏症以及甲状旁腺功能亢进症更为常见。行 LSG 后，叶酸缺乏更为常见（但无统计学意义）。所有患者的钙水平均正常；因此，甲状旁腺激素和维生素 D3 水平是检测钙代谢紊乱的更敏感标志物。缺铁性贫血通过 IV 治疗最有效。
