Azagury D E, Ris F, Pichard C, Volonté F, Karsegard L, Huber O
Both authors have contributed equally to this work; Gastrointestinal & Transplant Surgery Service, Department of Surgery, Geneva University Hospital, Geneva, Switzerland; Stanford University School of Medicine, Department of Surgery, Stanford, California.
Both authors have contributed equally to this work; Gastrointestinal & Transplant Surgery Service, Department of Surgery, Geneva University Hospital, Geneva, Switzerland.
Surg Obes Relat Dis. 2015 Jul-Aug;11(4):920-6. doi: 10.1016/j.soard.2014.10.016. Epub 2014 Oct 22.
Perioperative nutrition and preoperative oral carbohydrate loading (CHL) have a beneficial impact on the outcomes of gastrointestinal oncological surgery. However no data exists on their effect on morbidly obese patients.
Our aim was to establish the short-term and long-term impact of these modalities, notably on metabolically active lean body mass (LBM) - an important factor in maintaining long-term weight loss.
Patients undergoing laparoscopic Roux-en-Y gastric bypass were randomized to standard management or intervention: CHL drinks consumed 12 and 2 hours presurgery, and immediate postoperative peripheral parenteral nutrition. The primary outcome measured was LBM, measured by Bioelectrical Impedance Analysis (BIA), one and 12 months postsurgery. Secondary outcomes included excess weight loss (EBWL), 30-day complication rate, and length of stay.
Of the 203 randomized patients, 198 were included in the analysis. All 101 patients in the control group completed the one-year follow up and 76 completed the BIA. In the intervention group, 93 of 97 patients completed the one-year follow-up and 71 completed the BIA. At one and 12 months follow-up, body composition, LBM, or EBWL were comparable. There was no difference in operative outcomes, complications rates, or length of stay. There was no adverse effect in the intervention group.
In a highly homogeneous group of morbidly obese patients with one-year follow-up, CHL and short-term parenteral nutrition did not lead to significant or sustained LBM preservation or modification in EBWL. There was no significant decrease in complications or length of stay. Our study confirms the safety of these interventions, even in previously unstudied Type 2 diabetic patients.
围手术期营养和术前口服碳水化合物负荷（CHL）对胃肠道肿瘤手术的结局有有益影响。然而，尚无关于它们对病态肥胖患者影响的数据。
我们的目的是确定这些方式的短期和长期影响，特别是对代谢活跃的瘦体重（LBM）的影响，LBM是维持长期体重减轻的一个重要因素。
接受腹腔镜Roux-en-Y胃旁路手术的患者被随机分为标准管理组或干预组：术前12小时和2小时饮用CHL饮料，并在术后立即进行外周肠外营养。主要测量结局是术后1个月和12个月通过生物电阻抗分析（BIA）测量的LBM。次要结局包括超重减轻（EBWL）、30天并发症发生率和住院时间。
在203例随机分组的患者中，198例纳入分析。对照组的101例患者均完成了一年的随访，76例完成了BIA。在干预组中，97例患者中的93例完成了一年的随访，71例完成了BIA。在术后1个月和12个月的随访中，身体组成、LBM或EBWL具有可比性。手术结局、并发症发生率或住院时间无差异。干预组没有不良反应。
在一组进行了一年随访的高度同质的病态肥胖患者中，CHL和短期肠外营养并未导致显著或持续的LBM保留或EBWL改变。并发症或住院时间没有显著减少。我们的研究证实了这些干预措施的安全性，即使在之前未研究过的2型糖尿病患者中也是如此。
