限制型和吸收不良型减重手术后的外分泌胰腺功能和消化动力学：一项前瞻性、横断面、对比研究。
Exocrine pancreatic function and dynamic of digestion after restrictive and malabsorptive bariatric surgery: a prospective, cross-sectional, and comparative study.
机构信息
Department of Gastroenterology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Department of Gastroenterology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
出版信息
Surg Obes Relat Dis. 2021 Oct;17(10):1766-1772. doi: 10.1016/j.soard.2021.06.019. Epub 2021 Jul 6.
BACKGROUND
Gastrointestinal anatomical changes after restrictive and malabsorptive bariatric surgery lead to important disturbances in the process of digestion and absorption of nutrients and could lead to exocrine pancreatic insufficiency (EPI).
OBJECTIVE
The aim of the present study was to evaluate and to compare pancreatic function and the dynamic of digestion and absorption of nutrients after restrictive and malabsorptive bariatric surgical procedures.
SETTING
University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
METHODS
A prospective, observational, cross-sectional, comparative study of patients after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (BPD/DS) was carried out. Patients with obesity who did not undergo surgery were included as control group. Pancreatic function and the dynamic of digestion and absorption of nutrients were evaluated by the C-mixed triglyceride (C-MTG) breath test. Six-hour C-cumulative recovery rate (C-CRR), C exhalation peak, and 1-hour maximal C-CRR were calculated.
RESULTS
One-hundred five patients were included (mean age, 49.8 yr; 84 women). Six-hour C-CRR was significantly reduced after BPD/DS (P < .001) but not after SG and RYGB. EPI was present in 75% of patients after BPD/DS, 8.3% of patients after RYGB, and 4.3% of patients after SG. Compared with the control group who did not undergo surgery, digestion and absorption of nutrients tended to occur earlier after SG, whereas it was delayed after RYGB and mainly after BPD/DS (P < .001).
CONCLUSION
Bariatric surgery significantly alters the dynamic of the digestive process. EPI is very common after BPD/DS, frequent after RYGB, and less frequent after SG. This information is clinically relevant since EPI is a treatable condition associated with symptoms, nutritional deficiencies, and complications.
背景
限制型和吸收不良型减重手术后胃肠道解剖结构发生改变，导致营养消化吸收过程出现重要紊乱，从而可能导致外分泌胰腺功能不全（EPI）。
目的
本研究旨在评估和比较限制型和吸收不良型减重手术后胰腺功能和营养消化吸收的动态变化。
设置
西班牙圣地亚哥-德孔波斯特拉大学医院。
方法
对接受袖状胃切除术（SG）、Roux-en-Y 胃旁路术（RYGB）和胆胰分流十二指肠转位术（BPD/DS）的患者进行前瞻性、观察性、横断面、对照研究。纳入未接受手术的肥胖患者作为对照组。通过 C-混合三酸甘油脂（C-MTG）呼吸试验评估胰腺功能和营养消化吸收的动态变化。计算 6 小时 C-累积恢复率（C-CRR）、C 呼气峰值和 1 小时最大 C-CRR。
结果
共纳入 105 例患者（平均年龄 49.8 岁，84 例女性）。BPD/DS 后 6 小时 C-CRR 显著降低（P<0.001），但 SG 和 RYGB 后无显著降低。BPD/DS 后 75%的患者存在 EPI，RYGB 后 8.3%的患者存在 EPI，SG 后 4.3%的患者存在 EPI。与未接受手术的对照组相比，SG 后营养消化吸收较早发生，而 RYGB 和 BPD/DS 后则较晚发生（P<0.001）。
结论
减重手术显著改变了消化过程的动态变化。BPD/DS 后 EPI 非常常见，RYGB 后常见，SG 后少见。EPI 是一种可治疗的疾病，与症状、营养缺乏和并发症相关，因此这些信息具有临床意义。
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