Département de chirurgie bariatrique et générale, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Canada.
Département de chirurgie bariatrique et générale, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Canada.
Surg Obes Relat Dis. 2018 Jan;14(1):30-37. doi: 10.1016/j.soard.2017.08.028. Epub 2017 Nov 8.
Biliopancreatic diversion with duodenal switch (BPD-DS) is one of the most effective bariatric surgeries, in terms of weight loss and remission of co-morbidities. It is however associated with a significant risk of protein and nutritional deficiency, as well as gastrointestinal side effects.
To assess the effect of increasing the strict alimentary limb on weight loss, nutritional deficiency and quality of life, compared with standard BPD-DS.
University-affiliated tertiary care center.
Prospective randomized double blind (patient-evaluator) trial in which patients were assigned in a 1:1 ratio to undergo a modified BPD-DS with a long alimentary limb (1 m from Treitz ligament, n = 10) or a standard biliopancreatic diversion (strict alimentary limb of 1.5 m, n = 10). Common channel was kept at 100 cm in both groups. Follow-up at 12 months was completed in all patients.
Initial weight (126 ± 10 versus 125 ± 17, P = .92), age (40 ± 7 versus 37 ± 8, P = .35), and sex ratio (1 female/9 males) were similar in both groups. Excess weight loss and total weight loss were significantly higher in the standard BPD-DS group (93.4 ± 12% versus 73.3 ± 7%, P = .0007 and 46 ± 5.6% versus 37 ± 3.4%, P = .0004). The study group had significantly higher vitamin D, manganese, and copper levels at 12 months. Both groups had similar drop in glycated hemoglobin, cholesterol levels, and resolution of co-morbidities at 12 months. Long alimentary limb was associated with significantly less bowel movements a day (1.6 ± .97 versus 2.55 ± 1.01, P = .01), less gastrointestinal side effects (bloating and gas, P<.05) and required less pancreatic enzymes supplements (0 versus 40%, P = .04) and calcium supplement. Quality of life was significantly improved in both groups in all domains (all P<.05).
At 12 months, weight loss was lesser in the long alimentary limb group. There was however no difference in the remission of co-morbidities and higher levels of vitamin D, manganese, and copper. Gastrointestinal adverse effects and the need for pancreatic enzymes were less with similarly excellent quality of life at 12 months. Longer follow-up is necessary to evaluate long-term weight loss and nutritional deficiencies.
胆胰转流十二指肠转位术（BPD-DS）是最有效的减重手术之一，在减重和缓解合并症方面效果显著。然而，它与显著的蛋白质和营养缺乏以及胃肠道副作用相关。
评估增加严格的食物肠段对体重减轻、营养缺乏和生活质量的影响，与标准 BPD-DS 相比。
大学附属三级保健中心。
前瞻性随机双盲（患者-评估者）试验，患者按 1:1 比例分配，接受改良 BPD-DS 治疗，其中 10 例患者的食物肠段较长（距 Treitz 韧带 1m），10 例患者接受标准胆胰转流术（严格食物肠段 1.5m）。两组的共同通道均保持在 100cm。所有患者均完成 12 个月的随访。
两组患者的初始体重（126±10 与 125±17，P=.92）、年龄（40±7 与 37±8，P=.35）和性别比例（1 例女性/9 例男性）相似。标准 BPD-DS 组的超重体重减轻和总体重减轻明显更高（93.4±12%与 73.3±7%，P=.0007 和 46±5.6%与 37±3.4%，P=.0004）。研究组在 12 个月时维生素 D、锰和铜水平显著升高。两组患者在 12 个月时糖化血红蛋白、胆固醇水平和合并症的缓解情况相似。长食物肠段与每日排便次数明显减少（1.6±.97 与 2.55±1.01，P=.01）、胃肠道副作用（腹胀和气体，P<.05）和更少的胰腺酶补充剂（0 与 40%，P=.04）和钙补充剂相关。两组患者的所有生活质量领域均有显著改善（均 P<.05）。
12 个月时，长食物肠段组的体重减轻量较少。然而，在合并症的缓解方面，维生素 D、锰和铜的水平更高，并无差异。胃肠道不良反应和胰腺酶的需求减少，12 个月时生活质量同样优异。需要更长时间的随访来评估长期的体重减轻和营养缺乏情况。
