Endocrinology and Nutrition Department, Hospital de La Santa Creu i Sant Pau, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain.
Medicine Department, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain.
Obes Surg. 2019 Feb;29(2):585-592. doi: 10.1007/s11695-018-3562-8.
Information concerning the risk-benefit profile of bariatric surgery in subjects with liver cirrhosis is scarce. Our aim was to describe the long-term outcomes of bariatric surgery in a cohort of patients with liver cirrhosis submitted to bariatric surgery.
This was a multicenter, retrospective observational study performed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), with a review of patients with cirrhosis who had undergone bariatric surgery during the period from April 2004 to March 2017 in ten public reference hospitals in Spain.
Data on 41 patients with cirrhosis submitted to obesity surgery were collected (mean age 53.8 ± 7.9 years, 46.3% women, presurgical BMI 45 ± 8.3 kg/m). All but one patient belonged to Child-Pugh class A, and sleeve gastrectomy was conducted in 68.3% of cases. Percentage of total weight loss (%TWL) was 26.33 ± 8.3% and 21.16 ± 15.32% at 1 and 5 years after surgery, respectively. This was accompanied by a significant reduction of type 2 diabetes, high blood pressure, and dyslipidemia and by an improvement of liver enzymes over time. Model for End-Stage Liver Disease (MELD) index increased from 7.2 ± 1.9 to 9.8 ± 4.6 after 5 years. Seven patients (17%) developed early postsurgical complications. No postsurgical mortality was observed. During follow-up, only five patients developed liver decompensation.
Bariatric surgery in selected patients with liver cirrhosis has metabolic benefits that could have a positive impact on liver prognosis.
Controlledtrials.com Identifier: 10.1186/ISRCTN15009106.
关于肝硬化患者接受减重手术的风险效益情况的信息较为匮乏。我们的目的是描述在西班牙内分泌学会和营养学会肥胖症小组（GOSEEN）进行的一项多中心、回顾性观察性研究中，一组接受减重手术的肝硬化患者的长期结果。
该研究回顾性纳入了 2004 年 4 月至 2017 年 3 月期间在西班牙 10 家公立医院接受减重手术的肝硬化患者，共纳入 41 名患者（平均年龄 53.8 ± 7.9 岁，46.3%为女性，术前 BMI 为 45 ± 8.3kg/m²）。除 1 例患者外，其余患者均属于 Child-Pugh 分级 A 级，其中 68.3%的患者接受了袖状胃切除术。术后 1 年和 5 年的总体体重减轻百分比（%TWL）分别为 26.33 ± 8.3%和 21.16 ± 15.32%。同时，2 型糖尿病、高血压和血脂异常的比例显著降低，肝功能指标也随时间推移得到改善。术后 5 年，终末期肝病模型（MELD）指数从 7.2 ± 1.9 增加到 9.8 ± 4.6。7 例（17%）患者发生早期术后并发症。无术后死亡病例。随访期间，仅 5 例患者出现肝失代偿。
对于特定的肝硬化患者，减重手术具有代谢益处，可能对肝脏预后产生积极影响。
controlledtrials.com 标识符：10.1186/ISRCTN15009106。
