Ohri S K, Keane P F, Swift I, Sackier J M, Williamson R C, Thompson G R, Wood C B
Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.
Am J Gastroenterol. 1989 Jul;84(7):740-3.
Eleven patients with heterozygous familial hypercholesterolemia (type IIa) were treated by partial ileal bypass. Postoperatively, mean total cholesterol levels fell by 26% at 1 month, and then rose steadily to 20% below preoperative levels of 20-24 months. The rise in cholesterol levels was due in part to an increase in high density lipoprotein (HDL) cholesterol with a resultant improvement in the HDL:LDL ratio (LDL, low density lipoprotein). Five patients had refractory hypercholesterolemia and were treated with lovastatin. One of them was treated with a combination of lovastatin and LDL-apheresis. All patients experienced diarrhea which improved with time, but two patients required reversal of their bypass for intractable gas bloat syndrome. Each received lovastatin to control recrudescence of hypercholesterolamia following reversal. Ten patients are alive and well, but one patient died after a myocardial infarction 55 months postoperatively. The advent of lovastatin and other HMG COA reductase inhibitors is likely to decrease the use of partial ileal bypass to treat familial hypercholesterolemia.
11例杂合子家族性高胆固醇血症（IIa型）患者接受了部分回肠旁路手术治疗。术后1个月时，平均总胆固醇水平下降了26%，然后稳步上升，在术后20 - 24个月时比术前水平低20%。胆固醇水平的上升部分归因于高密度脂蛋白（HDL）胆固醇的增加，从而使HDL与低密度脂蛋白（LDL）的比值得到改善。5例患者患有难治性高胆固醇血症，接受了洛伐他汀治疗。其中1例患者接受了洛伐他汀与LDL去除术联合治疗。所有患者均出现腹泻，随着时间推移腹泻症状有所改善，但有2例患者因顽固性气体膨胀综合征需要逆转其旁路手术。每例患者在逆转手术后均接受洛伐他汀治疗以控制高胆固醇血症的复发。10例患者存活且情况良好，但有1例患者在术后55个月发生心肌梗死后死亡。洛伐他汀和其他HMG - COA还原酶抑制剂的出现可能会减少部分回肠旁路手术在治疗家族性高胆固醇血症中的应用。
