Sun Xia, Yao Libin, Kang Xing, Yu Weihua, Kitaghenda Fidele Kakule, Ibn Rashid Mohammad Sajjad, Taguemkam Angeline Nogue, Hong Jian, Dong Zhiyong, Sun Xitai, Zhu Xiaocheng
Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
Liver Res. 2024 Aug 26;8(3):172-178. doi: 10.1016/j.livres.2024.08.001. eCollection 2024 Sep.
Liver cirrhosis is a complex disease that may result in increased morbidity and mortality following bariatric surgery (BS). This study aimed to explore the outcome of BS in patients with unexpected cirrhosis, focusing on postoperative complications and the progression of liver disease.
A retrospective study of bariatric patients with cirrhosis from four centers in China between 2016 and 2023 was conducted, with follow-up for one year after BS. The primary outcome was the safety of BS in patients with unexpected cirrhosis, while the secondary outcome was the metabolic efficacy of BS in this group postoperatively.
A total of 47 patients met the study criteria, including 46 cases of Child-Pugh class A cirrhosis and 1 case of Child-Pugh B. Pathological examination confirmed nodular cirrhosis in 21 patients (44.68%), pseudolobule formation in 1 patient (2.13%), lipedema degeneration with inflammatory cell infiltration in 3 patients (6.38%), and chronic hepatitis in 1 patient (2.13%). The average percentage of total weight loss was 29.73 ± 6.53% at one year postoperatively. During the 30-day postoperative period, the complication rate was 6.38%, which included portal vein thrombosis, gastrointestinal bleeding, and intra-abdominal infection. Moreover, no cases of liver decompensation or mortality were reported during the follow-up period. The remission rates of comorbidities among 41 patients one year after surgery were as follows: dyslipidemia 100%, type 2 diabetes 82.61%, hypertension 84.62%, and obstructive sleep apnea syndrome 85.71%.
BS can be safely performed in patients with unexpected cirrhosis in the compensated stage of liver disease, with low postoperative morbidity and no mortality observed during one-year follow-up.
肝硬化是一种复杂疾病，可能导致减重手术后发病率和死亡率增加。本研究旨在探讨意外肝硬化患者减重手术的结局，重点关注术后并发症及肝病进展。
对2016年至2023年中国四个中心的肝硬化减重患者进行回顾性研究，减重手术后随访一年。主要结局是意外肝硬化患者减重手术的安全性，次要结局是该组患者术后减重手术的代谢疗效。
共有47例患者符合研究标准，其中Child-Pugh A级肝硬化46例，Child-Pugh B级1例。病理检查确诊为结节性肝硬化21例（44.68%），假小叶形成1例（2.13%），脂肪变性伴炎性细胞浸润3例（6.38%），慢性肝炎1例（2.13%）。术后一年总体重减轻的平均百分比为29.73±6.53%。术后30天内，并发症发生率为6.38%，包括门静脉血栓形成、胃肠道出血和腹腔内感染。此外，随访期间未报告肝失代偿或死亡病例。41例患者术后一年合并症的缓解率如下：血脂异常100%，2型糖尿病82.61%，高血压84.62%，阻塞性睡眠呼吸暂停综合征85.71%。
对于肝病代偿期意外肝硬化患者，减重手术可安全实施，术后发病率低，且在一年随访期间未观察到死亡病例。
