Rannem T, Hylander E, Jarnum S, Ladefoged K, Schaadt O, Staun M, Thale M
Medical Dept. A., Rigshospitalet, Copenhagen, Denmark.
Scand J Gastroenterol. 1990 Sep;25(9):897-905. doi: 10.3109/00365529008997610.
Calcium absorption and bone mineral content were studied prospectively in 30 patients with familial hypercholesterolaemia subjected to partial ileal bypass surgery. One-third of the patients were followed up for 10 years after the operation. Six months postoperatively calcium absorption decreased significantly, from a median of 16% to 13%. The effect persisted up to 5 years of follow-up study. Ten years after the operation the absorption of calcium (median, 14.5%) was not significantly different from the preoperative calcium absorption (median, 16%). Bone mineral content, measured in 76% of the patients, was retained in all patients studied. A significant correlation was present between calcium absorption and urinary calcium. The reduction in calcium absorption did not correlate with increases in faecal fat. Other long-term side effects were persistent diarrhoea and moderate steatorrhoea. A significant weight loss was slowly regained in most patients. An increase of renal oxalate excretion was only small and transient in most patients. The study shows that bypass of the terminal 200 cm of ileum for familial hypercholesterolaemia causes moderate diarrhoea and steatorrhoea in most patients but only a slight reduction of intestinal calcium absorption and apparently no risk of bone demineralization. A benefit of a postoperative calcium and vitamin D supply cannot be excluded.
对30例接受部分回肠旁路手术的家族性高胆固醇血症患者的钙吸收和骨矿物质含量进行了前瞻性研究。三分之一的患者在术后接受了10年的随访。术后6个月，钙吸收显著下降，中位数从16%降至13%。这种影响一直持续到5年的随访研究。术后10年，钙吸收（中位数，14.5%）与术前钙吸收（中位数，16%）无显著差异。在76%的患者中测量的骨矿物质含量在所有研究患者中均得以保留。钙吸收与尿钙之间存在显著相关性。钙吸收的降低与粪便脂肪增加无关。其他长期副作用是持续性腹泻和中度脂肪泻。大多数患者显著减轻的体重缓慢恢复。大多数患者肾草酸排泄的增加仅为少量且短暂。该研究表明，为家族性高胆固醇血症进行末段200厘米回肠旁路手术在大多数患者中会导致中度腹泻和脂肪泻，但仅使肠道钙吸收略有降低，且显然无骨质脱矿风险。不能排除术后补充钙和维生素D的益处。
