Eilenberg Magdalena, Langer Felix B, Beer Andrea, Trauner Michael, Prager Gerhard, Staufer Katharina
Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria.
Department of Pathology, Medical University of Vienna, Vienna, Austria.
Obes Surg. 2018 Mar;28(3):812-819. doi: 10.1007/s11695-017-2925-x.
Nonalcoholic fatty liver disease (NAFLD) occurs in up to 80% of patients with obesity. Current data suggest an improvement of NAFLD after established bariatric procedures.
This study investigated liver function impairment after Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB).
University Hospital, Bariatric Surgery Unit METHODS: In this single-center case series, consecutive in- and outpatients after bariatric surgery who presented with severe liver dysfunction from March 2014 to February 2017 were included and followed until March 2017.
In total, 10 patients (m:f = 2:8; median age 48 years, range 22-66 years) were included. Liver dysfunction occurred after a median postoperative time of 15 months (range 2-88 months). Median %excess weight loss at that time was 110.6% (range 85.2-155.5%). Liver steatosis/fibrosis occurred in 70%, cirrhosis in 30% of patients, and led to fatigue (90%), ascites (70%), hepatic encephalopathy (30%), and upper gastrointestinal bleeding (20%). Elevation of transaminases, impairment of coagulation parameters, thrombocytopenia, and hypoalbuminemia were present in 70, 80, 70, and 100%, respectively. In eight patients, lengthening of the alimentary/common limb led to an improvement or complete remission of symptoms. In one patient, liver transplantation was required, one patient deceased due to septic shock and decompensated liver disease.
Severe liver dysfunction may also occur after bariatric procedures such as OAGB and RYGB. A comprehensive, meticulous follow-up for early identification of postoperative liver impairment should be aspired. Bypass length reduction led to a fast improvement in all patients.
非酒精性脂肪性肝病（NAFLD）在高达80%的肥胖患者中出现。目前的数据表明，在既定的减肥手术后，NAFLD有所改善。
本研究调查了Roux-en-Y胃旁路术（RYGB）和单吻合口胃旁路术（OAGB）后的肝功能损害情况。
大学医院，减肥手术科
在这个单中心病例系列中，纳入了2014年3月至2017年2月期间接受减肥手术后出现严重肝功能障碍的连续住院和门诊患者，并随访至2017年3月。
总共纳入了10名患者（男:女 = 2:8；中位年龄48岁，范围22 - 66岁）。肝功能障碍发生在术后中位时间15个月（范围2 - 88个月）。此时的中位超重体重减轻百分比为110.6%（范围85.2 - 155.5%）。70%的患者出现肝脂肪变性/纤维化，30%的患者出现肝硬化，并导致疲劳（90%）、腹水（70%）、肝性脑病（30%）和上消化道出血（20%）。转氨酶升高、凝血参数受损、血小板减少和低白蛋白血症分别出现在70%、80%、70%和100%的患者中。8名患者中，延长消化道/共同肢体导致症状改善或完全缓解。1名患者需要进行肝移植，1名患者因感染性休克和失代偿性肝病死亡。
在OAGB和RYGB等减肥手术后也可能发生严重肝功能障碍。应致力于进行全面、细致的随访，以便早期识别术后肝功能损害。缩短旁路长度使所有患者迅速得到改善。
