Cazzo Everton, Pareja José Carlos, Chaim Elinton Adami
MD, MSc, PhD. Assistant Lecturer, Department of Surgery, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil.
MD, PhD. Associate Professor, Department of Surgery, Universidade Estadual de Campinas (Unicamp), Campinas (SP), Brazil.
Sao Paulo Med J. 2017 Jan-Feb;135(1):66-70. doi: 10.1590/1516-3180.2016.0129220616. Epub 2016 Nov 10.
: Occurrences of liver failure following jejunoileal bypass were extensively reported in the past and were one of the main factors that led to abandonment of this procedure. The newer predominantly malabsorptive procedures called biliopancreatic diversions (BPDs) have also been implicated in several cases of acute and subacute liver failure. The aim here was to review the current available evidence on occurrences of liver failure following BPDs.
: Narrative review; bariatric surgery service of a public university hospital.
: A review of the literature was conducted through an online search of medical databases.
: Associations between BPDs and liver failure have only infrequently been reported in the literature. However, they appear to be more than merely anecdotal. The pathophysiological mechanisms remain obscure, but they seem to be related to rapid weight loss, protein malnutrition, deficits of hepatotrophic factors, high circulating levels of free fatty acids and bacterial overgrowth in the bypassed bowel segments. Reversal of the BPD may ameliorate the liver impairment.
: Although infrequent, liver failure remains a concern following BPDs. Careful follow-up is required in individuals who undergo any BPD.
空肠回肠分流术后发生肝衰竭的情况在过去曾被广泛报道，且是导致该手术被弃用的主要因素之一。较新的主要导致吸收不良的手术，即胆胰分流术（BPD），也与几例急性和亚急性肝衰竭有关。本文旨在综述目前关于BPD术后肝衰竭发生情况的现有证据。
叙述性综述；一所公立大学医院的减肥手术科室。
通过在线检索医学数据库对文献进行综述。
文献中仅偶尔报道了BPD与肝衰竭之间的关联。然而，它们似乎并非只是个别现象。病理生理机制仍不清楚，但似乎与体重快速减轻、蛋白质营养不良、肝细胞营养因子缺乏、游离脂肪酸循环水平升高以及旷置肠段的细菌过度生长有关。逆转BPD可能会改善肝脏损害。
尽管BPD术后肝衰竭并不常见，但仍是一个需要关注的问题。接受任何BPD手术的患者都需要密切随访。
