[既往精神疾病对肥胖症手术患者术后病程的影响]

[Influence of previous psychiatric disorders on postoperative course in patients undergoing bariatric surgery].

作者信息

Botella Romero Francisco, Alfaro Martínez José Joaquín, Molina Pacheco Elena, Lomas Meneses Amparo, Salas Saiz María Angeles, García Gómez Angélica, García Arce Llanos

机构信息

Sección de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España.

出版信息

Endocrinol Nutr. 2010 Jan;57(1):9-15. doi: 10.1016/S1575-0922(10)70003-6.

DOI:10.1016/S1575-0922(10)70003-6

PMID:20172481

Abstract

INTRODUCTION

Presurgical evaluation of patients undergoing bariatric surgery includes, among others, a psychological/psychiatric evaluation. Psychiatric disorders that did not contraindicate surgery may persist and influence on weight loss and postoperative clinical course, hindering the success of the procedure. The aim of our study was to analyze the postoperative evolution of our series of patients with and without psychiatric symptoms before surgery.

PATIENTS AND METHODS

Retrospective analysis of 109 patients undergoing bariatric surgery with duodenal switch from 2003 to 2008 (follow up > 6 months). We studied weight changes, immediate and delayed complications of surgery and nutritional deficiencies in post-surgical follow-up in patients with previous psychiatric disorders (group 1, n = 17) compared with patients without psychiatric disorders (group 2, n = 92).

RESULTS

Patients in group 1 showed a greater tendency for weight gain. They regained a 9.4% of the initial excess weight lost between 18 months after surgery and 36 months after surgery, while patients in group 2 regained only 0.2% in the same period (p < 0.05). There was no difference in immediate surgical complications (5/17 vs 25/92 patients). The mean incidence of late surgical complications was 0.71 per patient in group 1 and 0.22 complications per patient in group 2 (p = 0.02). 52.9% of patients in group 1 had at least one late complication compared to 19.6% of patients in group 2 (p = 0.003). The three most common complications in patients with previous psychiatric disorders were chronic diarrhea, vomits and malnutrition. The presence of nutritional deficiencies were common in both groups, mainly soluble vitamins, iron and zinc. During postoperative follow-up, we found 3.1 +/- 1.6 nutritional deficiencies per patient in group 1 and 2.5 +/- 1.7 in group 2 (p = 0.04). More than three nutritional deficiencies were found in 8 patients in group 1 (52.9%) compared to 23 patients in group 2 (25%) (p = 0.03).

CONCLUSIONS

The presence of previous psychiatric disorders may be a predictor of a less positive outcome in morbidly obese patients who undergo bariatric surgery.

摘要

引言

接受减肥手术的患者的术前评估包括心理/精神评估等。不构成手术禁忌的精神疾病可能会持续存在，并影响体重减轻和术后临床过程，阻碍手术的成功。我们研究的目的是分析我们这组术前有或没有精神症状的患者的术后情况。

患者与方法

对2003年至2008年接受十二指肠转位减肥手术的109例患者进行回顾性分析（随访时间>6个月）。我们研究了有精神疾病史的患者（第1组，n = 17）与无精神疾病的患者（第2组，n = 92）在术后随访中的体重变化、手术的即时和延迟并发症以及营养缺乏情况。

结果

第1组患者体重增加的趋势更大。在术后18个月至36个月之间，他们重新获得了初始减重后多余体重的9.4%，而第2组患者在同一时期仅重新获得了0.2%（p < 0.05）。手术即时并发症方面无差异（第1组5/17例患者，第2组25/92例患者）。第1组患者后期手术并发症的平均发生率为每人0.71例，第2组为每人0.22例（p = 0.02）。第1组52.9%的患者至少有一项后期并发症，而第2组为19.6%（p = 0.003）。有精神疾病史的患者最常见的三种并发症是慢性腹泻、呕吐和营养不良。两组中营养缺乏情况都很常见，主要是水溶性维生素、铁和锌。在术后随访期间，我们发现第1组患者每人有3.1±1.6种营养缺乏，第2组为2.5±1.7种（p = 0.04）。第1组有8例患者（52.9%）发现有三种以上营养缺乏，而第2组为23例患者（25%）（p = 0.03）。