Gerhard Glenn S, Chokshi Ravi, Still Christopher D, Benotti Peter, Wood G Craig, Freedman-Weiss Mollie, Rider Cody, Petrick Anthony T
Weis Center for Research, Geisinger Clinic, 100 North Academy Avenue, Danville, PA 17822, USA.
Patient Saf Surg. 2011 Jan 10;5(1):1. doi: 10.1186/1754-9493-5-1.
Gastric bypass surgery is a highly effective therapy for long-term weight loss in severely obese patients, but carries significant perioperative risks including infection, wound dehiscence, and leaks from staple breakdown. Iron status can affect immune function and wound healing, thus may influence peri-operative complications. Common mutations in the HFE gene, the gene responsible for the iron overload disorder hereditary hemochromatosis, may impact iron status.
We analyzed 1064 extremely obese Caucasian individuals who underwent open and laparoscopic Roux-n-Y gastric bypass surgery at the Geisinger Clinic. Serum iron, ferritin, transferrin, and iron binding capacity were measured pre-operatively. All patients had intra-operative liver biopsies and were genotyped for the C282Y and H63D mutations in the HFE gene. Associations between surgical complications and serum iron measures, HFE gene status, and liver iron histology were determined.
We found that increased serum iron and transferrin saturation were present in patients with any post-operative complication, and that increased serum ferritin was also increased in patients with major complications. Increased serum transferrin saturation was also associated with wound complications in open RYGB, and transferrin saturation and ferritin with prolonged lengths of stay. The presence of 2 or more HFE mutations was associated with overall complications as well as wound complications in open RYGB. No differences were found in complication rates between those with stainable liver iron and those without.
Serum iron status and HFE genotype may be associated with complications following RYGB surgery in the extremely obese.
胃旁路手术是治疗重度肥胖患者长期减重的一种高效疗法，但存在显著的围手术期风险，包括感染、伤口裂开以及吻合钉断裂导致的渗漏。铁状态会影响免疫功能和伤口愈合，因此可能影响围手术期并发症。HFE基因（负责铁过载疾病遗传性血色素沉着症的基因）的常见突变可能会影响铁状态。
我们分析了1064例在盖辛格诊所接受开放和腹腔镜Roux - n - Y胃旁路手术的极度肥胖白种人个体。术前测量血清铁、铁蛋白、转铁蛋白和铁结合能力。所有患者均进行了术中肝脏活检，并对HFE基因的C282Y和H63D突变进行基因分型。确定手术并发症与血清铁指标、HFE基因状态和肝脏铁组织学之间的关联。
我们发现，任何术后并发症患者的血清铁和转铁蛋白饱和度均升高，主要并发症患者的血清铁蛋白也升高。血清转铁蛋白饱和度升高还与开放Roux - Y胃旁路手术的伤口并发症相关，转铁蛋白饱和度和铁蛋白与住院时间延长相关。存在2个或更多HFE突变与总体并发症以及开放Roux - Y胃旁路手术的伤口并发症相关。肝脏铁染色阳性和阴性患者的并发症发生率无差异。
血清铁状态和HFE基因型可能与极度肥胖患者接受Roux - Y胃旁路手术后的并发症有关。
