Sugerman H J, Starkey J V, Birkenhauer R
Ann Surg. 1987 Jun;205(6):613-24. doi: 10.1097/00000658-198706000-00002.
Vertical banded gastroplasty (VBGP) was compared with Roux-en-Y gastric bypass (RYGBP) in a randomized prospective trial that included preoperative dietary separation of "sweets eaters" versus "non-sweets eaters." Randomization was stopped at 9 months after 20 patients had undergone each procedure because a greater weight loss (p less than 0.05) was noted after RYGBP than VBGP. This difference became more significant (p less than 0.001) at each 3-month interval through 3 years, when patients who had VBGPs had lost 37 +/- 20% of excess weight compared with 64 +/- 19% for patients who had RYGBPs. The members of the groups were comparable with regard to age, sex, eating habits, morbidity rates before surgery, ideal body weight, and weight before surgery. Although there was no significant difference between the loss of excess weight in "sweets eaters" (69 +/- 17%) or "non-sweets eaters" (67 +/- 17%) after RYGBP at 1 year, "sweets eaters" who had VBGPs lost significantly less excess weight (36 +/- 13%) than did "non-sweets eaters" who had VBGPs (57 +/- 18%), p less than 0.02, or "sweets eaters" who had RYGBPs, p less than 0.0001. No significant differences were noted for electrolytes, renal or liver function tests, and most vitamins between patients who had VBGPs and RYGBPs; however, patients who had RYGBPs had lower (p less than 0.05) serum vitamin B12 levels (286 +/- 149 pg/dl) than did patients who had VBGPs (461 +/- 226 pg/dl) at 2 years. By 3 years, the vitamin B12 levels were equal in members of the two groups. Five patients who had RYGBPs required endoscopic stomal dilatation for stomal stenosis and one had a marginal ulcer develop, which responded to cimetidine. RYGBP was clearly superior to VBGP for "sweets eaters," probably because of the development of dumping syndrome symptoms. However, RYGBP was associated with a larger number of correctable problems. Thus, it is important to evaluate a patient's eating habits before surgery for morbid obesity; "non-sweets eaters" probably should be treated with VBGP and "sweets eaters" with RYGBP.
在一项随机前瞻性试验中，对垂直束带胃成形术（VBGP）和 Roux-en-Y 胃旁路术（RYGBP）进行了比较，该试验包括术前将“甜食爱好者”与“非甜食爱好者”进行饮食区分。在每种手术各有 20 例患者接受手术后 9 个月停止随机分组，因为发现 RYGBP 术后的体重减轻幅度大于 VBGP（p < 0.05）。在长达 3 年的时间里，每 3 个月的间隔期这种差异都变得更加显著（p < 0.001），接受 VBGP 的患者减重了多余体重的 37±20%，而接受 RYGBP 的患者减重了 64±19%。两组患者在年龄、性别、饮食习惯、术前发病率、理想体重和术前体重方面具有可比性。尽管在术后 1 年，RYGBP 术后“甜食爱好者”（69±17%）或“非甜食爱好者”（67±17%）的多余体重减轻幅度没有显著差异，但接受 VBGP 的“甜食爱好者”减重的多余体重（36±13%）明显少于接受 VBGP 的“非甜食爱好者”（57±18%），p < 0.02，也少于接受 RYGBP 的“甜食爱好者”，p < 0.0001。接受 VBGP 和 RYGBP 的患者在电解质、肾功能或肝功能检查以及大多数维生素方面没有显著差异；然而，在术后 2 年，接受 RYGBP 的患者血清维生素 B12 水平（286±149 pg/dl）低于接受 VBGP 的患者（461±226 pg/dl），p < 0.05。到术后 3 年，两组患者的维生素 B12 水平相等。5 例接受 RYGBP 的患者因吻合口狭窄需要内镜下吻合口扩张，1 例出现边缘性溃疡，使用西咪替丁治疗有效。对于“甜食爱好者”，RYGBP 明显优于 VBGP，可能是因为倾倒综合征症状的出现。然而，RYGBP 伴有更多可纠正的问题。因此，在对病态肥胖患者进行手术前评估其饮食习惯很重要；“非甜食爱好者”可能应采用 VBGP 治疗，“甜食爱好者”应采用 RYGBP 治疗。
