Borghede Märta, Vinter-Jensen Lars, Rasmussen Henrik H, Veedfald Simon, Rehfeld Jens F, Hartmann Bolette, Holst Jens J, Knop Filip K, Sonne David P
Center for Nutrition and Bowel Disease, Aalborg University Hospital, Aalborg, Denmark.
Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Physiol Rep. 2018 May;6(9):e13686. doi: 10.14814/phy2.13686.
A serious complication to the laparoscopic Roux-en-Y gastric bypass (RYGB) is internal hernia, which can lead to massive bowel necrosis that may result in short bowel syndrome. We determined postprandial enteropancreatic hormonal responses and metabolites in a 22-year-old nondiabetic woman with a history of RYGB experiencing severe internal herniation with widespread bowel necrosis. Extensive resections were performed leaving her with a saliva fistula from the pouch-enteric anastomosis, an intact duodenum, 15 cm of jejunum, 35 cm of ileum, and intact colon. Parenteral nutrition was initiated and 10 months after the bowel resection, intestinal continuity was re-established. After 6 weeks the patient reached parenteral nutrition independence. She underwent standardized liquid mixed meal tests before, 3 months after and 2 years after intestinal continuity was re-established. Gut hormone responses were completely restored postoperatively leading to very high concentrations in plasma. After 2 years, plasma concentrations had, however, decreased markedly, suggesting desensitization of the gut ostensibly in response to chronic hyperstimulation. There was no evidence of cephalic phase insulin secretion.
腹腔镜Roux-en-Y胃旁路术（RYGB）的一种严重并发症是内疝，它可导致大面积肠坏死，进而可能引发短肠综合征。我们对一名22岁、有RYGB病史、发生严重内疝并伴有广泛肠坏死的非糖尿病女性患者的餐后肠胰激素反应和代谢产物进行了测定。患者接受了广泛的肠切除，术后出现吻合口处唾液瘘，十二指肠完整，空肠15厘米，回肠35厘米，结肠完整。术后开始肠外营养，肠切除术后10个月重建肠道连续性。6周后患者实现了肠外营养自主。在肠道连续性重建前、重建后3个月和2年时，患者接受了标准化的液体混合餐试验。术后肠道激素反应完全恢复，导致血浆中激素浓度非常高。然而，2年后，血浆浓度显著下降，这表明肠道表面因慢性过度刺激而出现脱敏现象。没有证据表明存在头期胰岛素分泌。
