Boon A P, Thompson H, Baddeley R M
Department of Pathology, Medical School, University of Birmingham.
J Clin Pathol. 1988 Dec;41(12):1281-7. doi: 10.1136/jcp.41.12.1281.
To assess the pattern and severity of liver disease in patients who had undergone jejuno-ileal bypass for the treatment of morbid obesity, 23 patients were biopsied, all of whom had had intact bypasses for more than 10 years. These were examined by light and electron microscopy. Previous biopsy specimens from each patient, including specimens taken before bypass, were reviewed. Similar biopsy specimens were obtained from six obese patients undergoing gastroplasty. There was no evidence of cirrhosis, and mild or moderate degrees of fibrosis were found in only a few patients. Steatosis tended to persist after bypass, albeit to a lesser degree. Giant mitochondria and intramitochondrial filamentous inclusions were present in four of six specimens taken before gastroplasty and in 15 of 23 specimens taken after jejuno-ileal bypass, being especially numerous in those specimens showing little or no steatosis. It is suggested that such features reflect ultrastructural evidence of adaptation to an abnormal metabolic environment both in the morbidly obese and even many years after jejuno-ileal bypass. Their prognostic importance is unclear.
为评估接受空肠回肠分流术治疗病态肥胖症患者的肝脏疾病模式及严重程度，对23例患者进行了活检，所有患者的分流术均保持完整且已超过10年。对这些患者的活检组织进行了光镜和电镜检查。回顾了每位患者之前的活检标本，包括分流术前采集的标本。从6例接受胃成形术的肥胖患者中获取了类似的活检标本。未发现肝硬化证据，仅少数患者存在轻度或中度纤维化。分流术后脂肪变性往往持续存在，尽管程度较轻。胃成形术前采集的6份标本中有4份、空肠回肠分流术后采集的23份标本中有15份存在巨大线粒体和线粒体内丝状包涵体，在那些几乎没有或没有脂肪变性的标本中尤其多见。提示这些特征反映了病态肥胖患者以及空肠回肠分流术后多年对异常代谢环境适应的超微结构证据。其预后重要性尚不清楚。
