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与体重减轻、胆结石和胆总管结石相关的胆道并发症。

Biliary complications associated with weight loss, cholelithiasis and choledocholithiasis.

作者信息

Ribeiro Marcelo A, Tebar Gabriela K, Niero Helena B, Pacheco Leticia S

机构信息

Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Abu Dhabi 11001, United Arab Emirates.

Department of Surgery, Pontifical Catholic University of São Paulo-Campus Sorocaba, Sorocaba 18030070, SP, Brazil.

出版信息

World J Gastrointest Pharmacol Ther. 2024 Jul 5;15(4):95647. doi: 10.4292/wjgpt.v15.i4.95647.

Abstract

Biliary complications like cholelithiasis and choledocholithiasis are more common in bariatric surgery patients due to obesity and rapid weight loss. Patients with a body mass index > 40 face an eightfold risk of developing cholelithiasis. Post-bariatric surgery, especially after laparoscopic Roux-en-Y gastric bypass (LRYGB), 30% of patients develop biliary disease due to rapid weight loss. The aim of this review is to analyze the main biliary complications that occur after bariatric surgery and its management. A review of the literature was conducted mainly from 2010 up to 2023 with regard to biliary complications associated with bariatric patients in SciELO, PubMed, and MEDLINE. Patients undergoing LRYGB have a higher incidence (14.5%) of symptomatic calculi post-surgery compared to those undergoing laparoscopic sleeve gastrectomy at 4.1%. Key biliary complications within 6 to 12 months post-surgery include: Cholelithiasis: 36%; Biliary colic/dyskinesia: 3.86%; Acute cholecystitis: 0.98%-18.1%; Chronic cholecystitis: 70.2%; Choledocholithiasis: 0.2%-5.7% and Pancreatitis: 0.46%-9.4%. Surgeons need to be aware of these complications and consider surgical treatments based on patient symptoms to enhance their quality of life.

摘要

由于肥胖和体重快速下降,胆石症和胆总管结石等胆道并发症在减肥手术患者中更为常见。体重指数>40的患者患胆石症的风险高出八倍。减肥手术后,尤其是腹腔镜Roux-en-Y胃旁路术(LRYGB)后,30%的患者因体重快速下降而患上胆道疾病。本综述的目的是分析减肥手术后发生的主要胆道并发症及其管理方法。主要在2010年至2023年期间,针对SciELO、PubMed和MEDLINE上与减肥患者相关的胆道并发症进行了文献综述。接受LRYGB手术的患者术后出现有症状结石的发生率(14.5%)高于接受腹腔镜袖状胃切除术的患者(4.1%)。术后6至12个月内主要的胆道并发症包括:胆石症:36%;胆绞痛/运动障碍:3.86%;急性胆囊炎:0.98%-18.1%;慢性胆囊炎:70.2%;胆总管结石:0.2%-5.7%;胰腺炎:0.46%-9.4%。外科医生需要了解这些并发症,并根据患者症状考虑手术治疗,以提高患者的生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e5a/11229836/3078439d3919/95647-g001.jpg

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