Buchwald H, Moore R B, Varco R L
Ann Surg. 1974 Oct;180(4):384-92. doi: 10.1097/00000658-197410000-00002.
The first partial ileal bypass operation specifically for the reduction of plasma lipids was performed by us in 1963. Since then we have operated upon and followed for more than three months 126 hyperlipidemic patients. Clinical metabolic studies, before and after the procedure, have demonstrated a 60% decrease in cholesterol absorption, a 3.8-fold increase in total fecal steroid excretion, a 5.7-fold increase in cholesterol synthesis, a 3-fold increase in cholesterol turnover, and a one-third decrease in the miscible cholesterol pool. Circulating cholesterol levels have been lowered an average 41.1% from the preoperative but postdietary baseline. An average 53% cholesterol reduction has been achieved from a pretreatment baseline using a combination of dietary and surgical management. Plasma triglycerides have been reduced in primary hypertriglyceridemic patients (type IV) an average of 52.6% from their preoperative but postdietary baseline. One patient died in the hospital and there have been 13 late deaths over the past 10 years. Four cases of postoperative bowel obstruction required reoperation. Diarrhea following partial ileal bypass is, as a rule, transistory and not a significant problem. No appreciable weight loss results from partial ileal bypass, which is an obvious distinction from the results of the far more massive jejuno-ileal bypass procedure for obesity. We have not encountered hepatotoxic, lithogenic, or nephrolithiasis complications in our partial ileal bypass patients. Sixty-nine per cent of our patients with preoperative angina pectoris have postoperative improvement or total remission of this symptom complex. Serial appraisal of followup coronary arteriographic studies offers preliminary evidence for lesion regression. It is concluded that partial ileal bypass is the most effective means for lipid reduction available today; it is obligatory in its actions, safe, and associated with minimal side effects.
1963年我们首次进行了专门用于降低血脂的部分回肠旁路手术。从那时起，我们已对126例高脂血症患者进行了手术并随访了三个多月。手术前后的临床代谢研究表明，胆固醇吸收减少了60%，粪便中总类固醇排泄增加了3.8倍，胆固醇合成增加了5.7倍，胆固醇周转率增加了3倍，可混溶胆固醇池减少了三分之一。循环胆固醇水平比术前但饮食后的基线平均降低了41.1%。通过饮食和手术管理相结合，从治疗前基线算起，平均胆固醇降低了53%。原发性高甘油三酯血症患者（IV型）的血浆甘油三酯比术前但饮食后的基线平均降低了52.6%。一名患者在医院死亡，在过去10年中有13例晚期死亡。4例术后肠梗阻需要再次手术。部分回肠旁路术后的腹泻通常是暂时的，不是一个严重问题。部分回肠旁路手术不会导致明显的体重减轻，这与更为广泛的用于治疗肥胖症的空肠-回肠旁路手术的结果明显不同。我们的部分回肠旁路手术患者未出现肝毒性、致石性或肾结石并发症。我们术前患有心绞痛的患者中有69%术后症状改善或完全缓解。随访冠状动脉造影研究的系列评估提供了病变消退的初步证据。结论是，部分回肠旁路手术是目前可用的最有效的降脂方法；其作用是必然的，安全的，且副作用最小。
