Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA.
Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA.
Am J Surg. 2014 Jun;207(6):942-8. doi: 10.1016/j.amjsurg.2013.10.019. Epub 2014 Jan 4.
Obese patients developing short bowel syndrome (SBS) maintain a higher body mass index (BMI) and have increased risk of hepatobiliary complications. Our aim was to determine the effect of pre-resection gastric bypass (GBP) on SBS outcome.
We reviewed 136 adults with SBS: 69 patients with initial BMI < 35 were controls; 43 patients with BMI > 35 were the obese group; and 24 patients had undergone GBP before SBS.
BMI at 1, 2, and 5 years was similar in control and GBP groups, whereas obese patients had a persistently increased BMI. Eight (33%) of the GBP patients had a pre-resection BMI > 35, but post-SBS BMI was similar to those <35. Obese patients were more likely to wean off PN (47% vs 20% control and 12% GBP, P < .05). Radiographic fatty liver tended to be higher in the GBP group (54% vs 19% control and 35% obese). End-stage liver disease occurred more frequently in obese and GBP patients (30% and 33% vs 13%, P < .05).
Pre-resection GBP prevents the nutritional benefits of obesity but does not eliminate the increased risk of hepatobiliary disease in obese SBS patients. This occurs independent of pre-SBS BMI suggesting the importance of GBP itself or history of obesity rather than weight loss.
患有短肠综合征（SBS）的肥胖患者保持较高的体重指数（BMI），并增加肝胆并发症的风险。我们的目的是确定术前胃旁路术（GBP）对 SBS 结果的影响。
我们回顾了 136 名成人 SBS 患者：69 名初始 BMI<35 的患者为对照组；43 名 BMI>35 的患者为肥胖组；24 名患者在 SBS 前接受了 GBP。
对照组和 GBP 组的 BMI 在 1、2 和 5 年时相似，而肥胖患者的 BMI 持续增加。8 名（33%）GBP 患者术前 BMI>35，但 SBS 后的 BMI 与<35 的患者相似。肥胖患者更有可能停用 PN（47% vs 20%对照组和 12%GBP，P<.05）。影像学脂肪肝在 GBP 组中更为常见（54% vs 19%对照组和 35%肥胖组）。终末期肝病在肥胖和 GBP 患者中更为常见（30%和 33% vs 13%，P<.05）。
术前 GBP 预防了肥胖的营养益处，但不能消除肥胖 SBS 患者肝胆疾病风险的增加。这与 SBS 前 BMI 无关，表明 GBP 本身或肥胖史的重要性，而不是体重减轻。
