Topart Philippe, Becouarn Guillaume, Sallé Agnès, Ritz Patrick
Société de Chirurgie Viscérale, Clinique de l'Anjou, 142, avenue de Lattre de Tassigny, 49000 Angers, France.
Société de Chirurgie Viscérale, Clinique de l'Anjou, 142, avenue de Lattre de Tassigny, 49000 Angers, France.
Surg Obes Relat Dis. 2014 Sep-Oct;10(5):936-41. doi: 10.1016/j.soard.2014.02.007. Epub 2014 Feb 17.
Malabsorptive bariatric procedures require multiple vitamin supplements, especially regarding fat-soluble vitamins. The exact amount required to maintain normal serum concentrations is still largely unknown. Based on the initial postoperative prescription, we assessed the number of adjustments and the amount of vitamins/micronutrients to normalize the biological markers 2 years after the biliopancreatic diversion with duodenal switch (BPD/DS).
A total of 112 consecutive patients had a laparoscopic BPD/DS between February 2007 and November 2010 for a body mass index of 53.1±5.9 kg/m² at a private hospital. Complete blood checks with vitamin status were obtained at each of the 3-month interval visits during the 1(st) postoperative year as well as twice during the 2(nd) year.
Initially, all of the patients were prescribed daily 25,000 International units (IU) of vitamin A, 1000 mg of calcium, multivitamins, and 1900 IU of vitamin D3. Significant adjustments were necessary 3.6±1.1 times during this period. A total of 80% of the patients required added vitamin A, vitamin D, as well as calcium, zinc, and iron. After 2 years,≥20% of patients exhibited vitamin A and iron deficiency with low prealbumin or micropenic anemia. Seventy percent had vitamin D deficiency and 50% secondary hyperparathyroidism.
The initial prescription was insufficient to cover the requirements after BPD/DS. At least 3000 mg of calcium with 7000 IU of vitamin D, 50,000 IU of vitamin A, 40 mg of zinc, and 200 mg of iron must be prescribed to start with. The trend toward a decrease in 25 OH vitamin D and hyperparathyroidism remains difficult to control although it can result from increased bone turnover during the early postoperative period.
吸收不良型减肥手术需要多种维生素补充剂，尤其是脂溶性维生素。维持正常血清浓度所需的确切剂量在很大程度上仍不清楚。基于术后初始处方，我们评估了胆胰转流十二指肠转位术（BPD/DS）后2年使生物学指标正常化所需的调整次数以及维生素/微量营养素的剂量。
2007年2月至2010年11月期间，一家私立医院共有112例连续患者接受了腹腔镜BPD/DS手术，其体重指数为53.1±5.9kg/m²。术后第1年每3个月随访一次，术后第2年随访两次，每次均进行全血细胞检查及维生素状态检查。
最初，所有患者均每日服用25000国际单位（IU）维生素A、1000mg钙、多种维生素以及1900IU维生素D3。在此期间，需要进行3.6±1.1次显著调整。共有80%的患者需要额外补充维生素A、维生素D以及钙、锌和铁。2年后，≥２０％的患者出现维生素A和铁缺乏，伴有前白蛋白水平低或小细胞性贫血。70%的患者存在维生素D缺乏，50%的患者有继发性甲状旁腺功能亢进。
BPD/DS术后的初始处方不足以满足需求。开始时必须至少开具3000mg钙、7000IU维生素D、50000IU维生素A、40mg锌和200mg铁。尽管术后早期骨转换增加可能导致25羟维生素D水平下降和甲状旁腺功能亢进，但这种趋势仍难以控制。
