Salgado Júnior Wilson, Donadelli Carlos Augusto de Mattos, Dos Santos José Sebastião, Nonino Carla Barbosa
Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Nutritional Division of the Department of Medical Clinic, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Obes Surg. 2016 Nov;26(11):2718-2723. doi: 10.1007/s11695-016-2176-2.
Obesity is associated with nonalcoholic fatty liver disease (NAFLD), which is improved by bariatric surgery. Hepatobiliary scintigraphy with 99m.-Tc diisopropylacetanilido iminodiacetic acid (99mTc-DISIDA) has proved to be highly effective for the assessment of bile flow, representing an indirect measurement of hepatocyte and cholangiocyte function. The objective of this study was to assess the effects of Roux-en-Y gastric bypass (RYGB) on bile flow in obese subjects by hepatobiliary scintigraphy. This study was conducted in a public university hospital in Brazil.
Twenty obese patients and five nonobese patients (with no hepatic or biliary disease) were studied. The obese patients were submitted to anthropometric evaluation and biochemical exams when they arrived at the service, during the immediate preoperative period and 3, 6, and 12 months after surgery. They were also submitted to abdominal ultrasound and hepatobiliary scintigraphy with 99mTc-DISIDA during the preoperative period and 12 months after RYGB. Tmax (time of maximum marker uptake) and T1/2 (half time between peak uptake and disappearance of the marker) were determined and compared between obese patients and controls, before and after surgery. The results were compared to those obtained with an intraoperative liver biopsy.
A weight loss of 12.2 ± 4.3 % was observed during preparation for surgery, and a loss of 30.4 ± 5.6 % was observed 1 year after RYGB. Ultrasound hepatic analysis revealed some degree of NAFLD in the operated patients. Obese patients showed a prolonged T1/2 compared to control, with a reduction to normal levels after RYGB.
We concluded that NAFLD compromises bile excretion, a process that can be reversed by treatment with RYGB.
肥胖与非酒精性脂肪性肝病（NAFLD）相关，而减肥手术可改善该疾病。用99m锝二异丙基乙酰苯胺亚氨基二乙酸（99mTc - DISIDA）进行肝胆闪烁显像已被证明对胆汁流动评估非常有效，它是肝细胞和胆管细胞功能的一种间接测量方法。本研究的目的是通过肝胆闪烁显像评估Roux - en - Y胃旁路术（RYGB）对肥胖受试者胆汁流动的影响。本研究在巴西的一家公立大学医院进行。
对20名肥胖患者和5名非肥胖患者（无肝脏或胆道疾病）进行研究。肥胖患者在就诊时、术前即刻、术后3个月、6个月和12个月接受人体测量评估和生化检查。他们还在术前和RYGB术后12个月接受腹部超声和用99mTc - DISIDA进行的肝胆闪烁显像。测定并比较肥胖患者与对照组在手术前后的Tmax（最大标记物摄取时间）和T1/2（标记物峰值摄取与消失之间的半衰期）。将结果与术中肝活检获得的结果进行比较。
在手术准备期间观察到体重减轻12.2±4.3%，RYGB术后1年体重减轻30.4±5.6%。超声肝脏分析显示手术患者存在一定程度的NAFLD。与对照组相比，肥胖患者的T1/2延长，RYGB术后降至正常水平。
我们得出结论，NAFLD损害胆汁排泄，而RYGB治疗可逆转这一过程。
