Department of Digestive Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
J Gastrointest Surg. 2011 Sep;15(9):1532-6. doi: 10.1007/s11605-011-1617-4. Epub 2011 Jul 13.
The aim of this study was to determine the incidence of symptomatic gallstone disease requiring cholecystectomy (CCE) after laparoscopic Roux-en-Y gastric bypass (LRYGBP) and to identify the peri-operative risk factors associated with postoperative symptomatic gallstone disease.
Between August 2003 and November 2009, 724 patients underwent LRYGBP at the Groeninge Hospital. Preoperative ultrasound was performed in 600 of 641 patients without history of CCE and 120 (20.0%) were diagnosed with cholecystolithiasis.
Six hundred twenty-five patients were included, 43(6.9%) developed delayed symptoms related to biliary disease. Of these 43 patients, 39 underwent post-LRYGBP CCE. Of these 39 patients, 9 (7.5%) had a positive ultrasound prior to LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGB of more than 50% of excess weight [HR (95% CI), 2.04 (1.04-4.28); p = 0.037) as the sole significant independent predictor of delayed symptomatic cholecystolithiasis.
Symptomatic gallstone disease occurred only in 6.9% of patients post-LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGBP of more than 50% of excess weight as the sole significant independent predictor of delayed symptomatic cholecystolithiasis. Prophylactic CCE should not be recommended at the time of LRYGBP.
本研究旨在确定腹腔镜 Roux-en-Y 胃旁路术（LRYGBP）后需要胆囊切除术（CCE）治疗的有症状胆囊疾病的发病率，并确定与术后有症状胆囊疾病相关的围手术期风险因素。
2003 年 8 月至 2009 年 11 月，724 例患者在 Groeninge 医院接受了 LRYGBP。在没有 CCE 病史的 641 例患者中的 600 例中进行了术前超声检查，其中 120 例（20.0%）被诊断为胆石症。
625 例患者被纳入研究，其中 43 例（6.9%）出现与胆道疾病相关的延迟症状。在这 43 例患者中，39 例行 LRYGBP 后 CCE。在这 39 例患者中，9 例（7.5%）在 LRYGBP 前超声检查阳性。多变量分析确定 LRYGBP 后 3 个月体重减轻超过超重的 50%[风险比（95%可信区间），2.04（1.04-4.28）；p = 0.037]是延迟性有症状胆石症的唯一显著独立预测因素。
LRYGBP 后仅 6.9%的患者出现有症状胆囊疾病。多变量分析确定 LRYGBP 后 3 个月体重减轻超过超重的 50%是延迟性有症状胆石症的唯一显著独立预测因素。LRYGBP 时不应推荐预防性 CCE。
