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胆肠吻合术十年随访:长期代谢结果是否需要吸收不良?

Ten years of follow-up of bilio-intestinal bypass: is malabsorption necessary for long-term metabolic results?

作者信息

Vitiello Antonio, Vincenzo Pilone, Formato Antonio, Izzo Giuliano, Ferraro Luca, Forestieri Pietro

机构信息

Department of Endocrinology, Gastroenterology and Surgery, University Hospital of Naples "Federico II", Naples, Italy.

Department of Medicine Surgery and Dentistry, University Hospital of Salerno, Salerno, Italy.

出版信息

Langenbecks Arch Surg. 2018 Nov;403(7):873-879. doi: 10.1007/s00423-018-1717-7. Epub 2018 Oct 20.

Abstract

BACKGROUND

Bilio-intestinal bypass (BIBP) is an uncommon bariatric procedure. In 1999, a prospective trial was started at our institution to evaluate the effectiveness of BIBP. Trial was interrupted in 2006 due to high rate of complications. The aim of the present paper was to retrospectively review 10-year outcomes of BIBP.

METHODS

Retrospective review of bariatric database was performed to find patients that had undergone BIBP from 1999 to 2006. Data collected were as follows: age, gender, body weight, body mass index (BMI), percentage of excess weight loss (%EWL), remission from weight-related diseases, complications, and deaths at 1,3, 5, 7, and 10 years. Quality of life was evaluated using "BAROS" questionnaire.

RESULTS

From May 1999 to September 2006, 86 patients underwent BIBP. The mean age was 34.9 ± 22.4 years, and the initial weight and BMI were 141.2 ± 40.4 kg and 49.8 ± 15.5 kg/m, respectively. After 10 years, the mean %EWL and BMI were 72.6 ± 18.7 and 31.2 ± 5.6 kg/m. Almost all patients had diarrhea after surgery. Bloating syndrome occurred in 24% of patients, 48% had nephrolithiasis, and 20.9% had cholelithiasis. Remission from diabetes and hypertension was obtained in 75% and 80% of patients. Mortality was 3.2% and reoperation rate was 14.5%.

CONCLUSIONS

Malabsorption plays a determinant role to obtain a long-lasting treatment for obese patients. However, BIBP is not recommendable due to high rate of complications and metabolic disorders.

摘要

背景

胆肠转流术(BIBP)是一种不常见的减肥手术。1999年,我们机构启动了一项前瞻性试验以评估BIBP的有效性。该试验于2006年因并发症发生率高而中断。本文的目的是回顾性分析BIBP的10年疗效。

方法

对减肥数据库进行回顾性分析,以找出1999年至2006年期间接受过BIBP手术的患者。收集的数据如下:年龄、性别、体重、体重指数(BMI)、超重减轻百分比(%EWL)、与体重相关疾病的缓解情况、并发症以及1年、3年、5年、7年和10年时的死亡情况。使用“BAROS”问卷评估生活质量。

结果

1999年5月至2006年9月,86例患者接受了BIBP手术。平均年龄为34.9±22.4岁,初始体重和BMI分别为141.2±40.4 kg和49.8±15.5 kg/m²。10年后,平均%EWL和BMI分别为72.6±18.7和31.2±5.6 kg/m²。几乎所有患者术后都有腹泻。24%的患者出现腹胀综合征,48%有肾结石,20.9%有胆结石。75%的患者糖尿病缓解,80%的患者高血压缓解。死亡率为3.2%,再次手术率为14.5%。

结论

吸收不良在肥胖患者的长期治疗中起决定性作用。然而,由于并发症发生率高和代谢紊乱,不推荐使用BIBP。

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