Nergård B J, Leifson B G, Gislason H, Hedenbro J L
Aleris Obesity Skåne, Malmö-Kristianstad, Lund, Sweden.
Department of Surgery, Lund University, Lund, Sweden.
BJS Open. 2020 Sep 15;4(6):1109-16. doi: 10.1002/bjs5.50334.
Distal Roux-en-Y gastrojejunal bypass (DRYGJB) gives better weight reduction than standard Roux-en-Y gastric bypass (RYGB) but at the risk of increased malnutrition side-effects. This study compared the effects of RYGB and DRYGJB on gastrointestinal symptoms, eating patterns and health-related quality of life (QoL).
This was a single-blind RCT from a university-affiliated obesity centre. Patients with a BMI of 50 kg/m or above were invited to participate. Treatment arms were standard gastric bypass with an alimentary limb of 150 cm and a biliopancreatic limb of 60 cm, with a variable common channel length, or DRYGJB with biliopancreatic limb of 200 cm, common channel limb of 150 cm and variable alimentary limb length. Baseline and follow-up data to 5 years on quality of life, obesity-related problems and gastrointestinal symptoms were collected using prospectively created and validated questionnaires.
Some 140 patients were included. Those with a DRYGJB had better weight loss at 5 years (mean(s.d.) 68·3(21·8) kg versus 55·7(19·8) kg for standard RYGB; P = 0·011). Eating patterns improved, with no difference between the groups. Gastrointestinal symptoms (diarrhoea, indigestion) worsened significantly in both groups, but only patients with DRYGJB had significantly worse diarrhoea at the end of the study than at baseline (P = 0·006). Both groups had improved perceived generic QoL over baseline, and obesity-related problems were markedly reduced.
Standard RYGB and both improved generic and disease-specific QoL and eating behavioural pattern. Diarrhoea was increased more following DRYGJB than after RYGB. Registration number: NCT01514799 (https://clinicaltrials.gov).
远端Roux-en-Y胃空肠旁路术（DRYGJB）在减重方面比标准Roux-en-Y胃旁路术（RYGB）效果更好，但存在营养不良副作用增加的风险。本研究比较了RYGB和DRYGJB对胃肠道症状、饮食模式及健康相关生活质量（QoL）的影响。
这是一项来自大学附属肥胖中心的单盲随机对照试验。邀请体重指数（BMI）为50kg/m²及以上的患者参与。治疗组分别为标准胃旁路术，其 alimentary 袢长150cm，胆胰袢长60cm，共同通道长度可变；或DRYGJB，胆胰袢长200cm，共同通道袢长150cm，alimentary 袢长度可变。使用前瞻性创建并验证的问卷收集生活质量、肥胖相关问题和胃肠道症状的基线及随访至5年的数据。
共纳入约140例患者。接受DRYGJB的患者在5年时减重效果更好（平均（标准差）68.3（21.8）kg，标准RYGB为55.7（19.8）kg；P = 0.011）。饮食模式有所改善，两组间无差异。两组的胃肠道症状（腹泻、消化不良）均显著恶化，但仅接受DRYGJB的患者在研究结束时腹泻比基线时显著更严重（P = 0.006）。两组的总体生活质量感知均较基线有所改善，肥胖相关问题显著减少。
标准RYGB以及DRYGJB均改善了总体和疾病特异性生活质量及饮食行为模式。DRYGJB后腹泻的增加比RYGB后更明显。注册号：NCT01514799（https://clinicaltrials.gov）
