Tovey F I, Godfrey J E, Lewin M R
Department of Surgery, University College London, Rayne Institute, UK.
Postgrad Med J. 1990 Jun;66(776):450-6. doi: 10.1136/pgmj.66.776.450.
Prior to 1960 a Polya gastrectomy was the most frequent operation for duodenal ulcer. The majority of these patients now have reached the age of sixty or older. A prospective longitudinal study of a cohort of patients who underwent gastrectomy between 1955 and 1960 was undertaken. Twenty five to thirty years later the study has revealed the extent of the nutritional problems that may arise with the passage of time and shows that these numerically far outweigh the mechanical post-gastrectomy syndromes and weight loss which tended to dominate the earlier post-gastrectomy scene. By the end of the first decade, iron deficiency was the commonest nutritional problem. Vitamin B12 deficiency assumed more importance in the second decade. During the third decade both reached equal prevalence, being found in some 90% of the female and 70% of the male residual population. Vitamin D deficiency and early osteomalacia was a lesser problem, reaching its climax in the second decade. Evidence suggested a high incidence of osteoporosis and this requires further investigation. Overall, women fared worse than men with a higher and earlier incidence of iron deficiency, particularly in the pre-menopausal group. This study emphasizes the increasing need for regular screening of post-gastrectomy patients to detect early iron, vitamin B12 and vitamin D deficiencies as patients grow older.
1960年以前，波伊亚胃切除术是十二指肠溃疡最常见的手术方式。这些患者中的大多数现已年满60岁或以上。对1955年至1960年间接受胃切除术的一组患者进行了一项前瞻性纵向研究。25至30年后，该研究揭示了随着时间推移可能出现的营养问题的程度，并表明从数量上看，这些问题远远超过了胃切除术后早期占主导地位的机械性胃切除术后综合征和体重减轻。到第一个十年末，缺铁是最常见的营养问题。维生素B12缺乏在第二个十年变得更加重要。在第三个十年，两者的患病率相当，在约90%的女性和70%的男性残余人群中被发现。维生素D缺乏和早期骨软化症是一个较小的问题，在第二个十年达到顶峰。有证据表明骨质疏松症的发病率很高，这需要进一步调查。总体而言，女性的情况比男性更糟，缺铁的发病率更高且出现得更早，尤其是在绝经前组。这项研究强调，随着患者年龄的增长，越来越需要对胃切除术后的患者进行定期筛查，以检测早期的铁、维生素B12和维生素D缺乏。
