Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Surg Obes Relat Dis. 2011 Mar-Apr;7(2):189-93. doi: 10.1016/j.soard.2010.08.018. Epub 2010 Oct 11.
The purpose of the present study was to evaluate the safety, efficacy, and nutritional outcomes of malabsorptive distal Roux-en-Y gastric bypass (D-RYGB) 20-25 years later at a university hospital.
From 1985 to 1989, 49 mostly superobese (body mass index >50 kg/m(2)) patients had undergone D-RYGB. D-RYGB consisted of open laparotomy with a 50-mL proximal gastric pouch and gastroenterostomy performed 250 cm proximal to the ileocecal junction, with common channels of 50-150 cm. These 49 patients were compared with a similar group of 92 consecutive patients who had undergone long-limb RYGB, with a 75-cm biliopancreatic limb and 150-cm alimentary limb.
The mean ± SD preoperative body mass index was 58.9 ± 9.3 kg/m(2). After 1 perioperative death secondary to pulmonary embolism, limb-lengthening revisions were required in 21 (43.7%) of the 48 remaining patients for protein-calorie malnutrition. Of the 23 with a 50-cm common channel, 13 required revision compared with 8 of 25 with ≥100-cm common channel (P <.05, chi-square). Of the 48 patients who had undergone D-RYGB, 8 had died 6-19 years after D-RYGB. Of the nonrevised patients, 19 (70.4%) of 27 had >5 years of follow-up. In these, the latest body mass index was 34.2 kg/m(2) at 10 ± 6.1 years. The percentage of excess weight loss was 66.8% ± 14%. The lowest late serum albumin level was 3.4 ± .5 g/dL (range 2.3-4.4). The mean 25-hydroxy vitamin D level was 14.6 ± 11.3 ng/mL. Compared with patients who had undergone long-limb RYGB, the D-RYGB patients had a significantly greater percentage of excess weight loss after 5 years but significantly lower albumin, hemoglobin, iron, and calcium levels.
Although D-RYGB afforded superior long-term weight loss, it caused protein-calorie malnutrition requiring frequent revision. The nonrevised patients had frequent severe metabolic derangements. Thus, D-RYGB should not be the primary operation for morbid or superobese patients.
本研究旨在评估大学医院接受吸收不良型远端胃旁路术（D-RYGB）20-25 年后的安全性、疗效和营养结局。
1985 年至 1989 年，49 例主要为超级肥胖（体重指数>50kg/m2）患者接受了 D-RYGB。D-RYGB 采用开放性剖腹手术，近端胃袋为 50ml，胃空肠吻合术在回盲肠交界处近端 250cm 处进行，共同通道为 50-150cm。将这 49 例患者与 92 例连续接受长肢 RYGB 的相似组进行比较，长肢 RYGB 的胆胰支为 75cm，营养支为 150cm。
术前平均（SD）体重指数为 58.9 ± 9.3kg/m2。在 1 例因肺栓塞而导致的围手术期死亡后，48 例存活患者中有 21 例（43.7%）因蛋白-热量营养不良需要进行肢体延长修正。在 23 例共同通道为 50cm 的患者中，有 13 例需要修正，而在 25 例共同通道≥100cm 的患者中，有 8 例需要修正（P<.05，卡方检验）。在接受 D-RYGB 的 48 例患者中，有 8 例在 D-RYGB 后 6-19 年内死亡。在未修正的患者中，有 19 例（70.4%）有>5 年的随访。在这些患者中，最新的体重指数在 10±6.1 年后为 34.2kg/m2。多余体重减轻的百分比为 66.8%±14%。血清白蛋白水平的最低值为 3.4±0.5g/dL（范围 2.3-4.4）。平均 25-羟维生素 D 水平为 14.6±11.3ng/mL。与接受长肢 RYGB 的患者相比，D-RYGB 患者在 5 年后的多余体重减轻百分比显著更高，但白蛋白、血红蛋白、铁和钙水平显著更低。
尽管 D-RYGB 提供了长期体重减轻的优势，但它导致了需要频繁修正的蛋白-热量营养不良。未修正的患者经常出现严重的代谢紊乱。因此，D-RYGB 不应该成为病态或超级肥胖患者的主要手术。
