Pestana Laura, Swain James, Dierkhising Ross, Kendrick Michael L, Kamath Patrick S, Watt Kymberly D
Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Department of Surgery, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2015 Feb;90(2):209-15. doi: 10.1016/j.mayocp.2014.11.012.
To assess safety and outcomes (metabolic and liver) of bariatric surgery in patients with cirrhosis with or without portal hypertension.
This study is a retrospective review of 14 patients with Child's A cirrhosis with or without portal hypertension who were prospectively enrolled from February 23, 2009, through November 9, 2011, with 6- to 24-month follow-up after bariatric surgery (11 patients underwent sleeve gastrectomy [78.6%] and 3 gastric bypass [21.4%]). Four patients had portal hypertension detected by esophagogastroduodenoscopy.
The mean patient age was 55.5 years, and 10 of 14 patients were women. The mean weight decreased from 125±18 to 94±17 at 1 year (P<.001) and 93±17 kg at 2 years (P<.001) postsurgery. The prevalence of diabetes decreased from 10 of 14 patients to 4 of 12 (P=.01) and 1 of 6 (P=.02) at 1 and 2 years postsurgery. The frequency of dyslipidemia and hypertension decreased but was not statistically significant; however, the number of medications required to control them decreased. Hepatic steatosis was detected by perioperative liver biopsy in 13 of 14 patients (5%-30% steatosis in 6 patients, 31%-60% in 6, and >60% in 1). At 1 year postsurgery, only 1 of 8 patients who underwent follow-up ultrasound imaging showed evidence of steatosis. The bilirubin level was above 2 mg/dL in 1 patient at 1 year postsurgery. One patient had encephalopathy at 2 years postsurgery. None of the patients developed peri- or postoperative bleeding or surgical complications.
Bariatric surgery in patients with compensated cirrhosis even with mild portal hypertension is well tolerated and safe with minimal risk of postoperative complications if performed in a large referral center. This population can experience the beneficial effects of weight loss and improved metabolic syndrome, as well as reduced hepatic steatosis.
评估肥胖症手术治疗伴有或不伴有门静脉高压的肝硬化患者的安全性及预后（代谢和肝脏方面）。
本研究对2009年2月23日至2011年11月9日期间前瞻性纳入的14例Child's A级肝硬化伴有或不伴有门静脉高压的患者进行回顾性分析，肥胖症手术后进行6至24个月的随访（11例患者接受袖状胃切除术[78.6%]，3例接受胃旁路手术[21.4%]）。4例患者经食管胃十二指肠镜检查发现门静脉高压。
患者平均年龄为55.5岁，14例患者中有10例为女性。术后1年时平均体重从125±18降至94±17（P<0.001），术后2年时降至93±17 kg（P<0.001）。糖尿病患病率在术后1年时从14例中的10例降至12例中的4例（P = 0.01），术后2年时降至6例中的1例（P = 0.02）。血脂异常和高血压的发生率有所下降，但差异无统计学意义；然而，控制这些疾病所需的药物数量减少。14例患者中有13例在围手术期肝活检时发现肝脂肪变性（6例患者脂肪变性为5%-30%，6例为31%-60%，1例>60%）。术后1年，8例接受随访超声检查的患者中只有1例有脂肪变性迹象。术后1年时有1例患者胆红素水平高于2 mg/dL。术后2年时有l例患者发生肝性脑病。所有患者均未发生围手术期或术后出血或手术并发症。
对于代偿期肝硬化患者，即使伴有轻度门静脉高压，在大型转诊中心进行肥胖症手术耐受性良好且安全，术后并发症风险极小。这类患者可体验到体重减轻、代谢综合征改善以及肝脂肪变性减轻的有益效果。
