Scopinaro N, Gianetta E, Adami G F, Friedman D, Traverso E, Marinari G M, Cuneo S, Vitale B, Ballari F, Colombini M, Baschieri G, Bachi V
Department of Surgery, University of Genoa School of Medicine, Italy.
Surgery. 1996 Mar;119(3):261-8. doi: 10.1016/s0039-6060(96)80111-5.
Surgical attempts to treat obesity began because of the discouraging results of conservative medical treatment, which successfully achieved initial weight loss but failed to maintain it. Gastric restrictive procedures, currently the most popular surgical methods for obesity therapy, have proved to be effective in initiating weight loss, but some concerns regarding their long-term efficacy in weight maintenance have arisen.
Of a total of 1968 obese patients who underwent biliopancreatic diversion since 1976, the last consecutive 1217 underwent the "ad hoc stomach" type of diversion with a 200 cm alimentary limb, a 50 cm common limb, and a gastric volume varying between 200 and 500 ml. Mean age was 37 years old (11 to 69 years), and mean excess weight was 117%. Maximum follow-up was 115 months with nearly 100% participation.
In the last half of the series, operative mortality was 0.4% with no general complications and with early surgical complications of wound dehiscence and infection (total, 1.2%) and late complications of incisional hernia (8.7%) and intestinal obstruction (1.2%). Mean percent loss initial excess weight (IEW) at 2, 4, 6, and 8 years was 78 +/- 16, 75 +/- 16, 78 +/- 18, and 77 +/- 16 in the patients with IEW up to 120% and 74 +/- 12, 73 +/- 13, 73 +/- 12, and 72 +/- 10 in those with IEW more than 120%. A group of 40 patients who underwent the original "half-half" biliopancreatic diversion maintained a mean 70% reduction of IEW during a 15-year follow-up period. Specific late complications included anemia (less than 5%), stomal ulcer (2.8%), protein malnutrition (7% with 1.7% requiring surgical revision by common limb elongation or by restoration). Clinical problems from bone demineralization were minimal in the short term and almost absent in the long term.
Biliopancreatic diversion is a very effective procedure but is potentially dangerous if used incorrectly.
由于保守药物治疗效果不佳，手术治疗肥胖症的尝试应运而生。保守药物治疗虽能成功实现初期体重减轻，但无法维持减重效果。目前，胃限制性手术是治疗肥胖症最常用的手术方法，已被证明在启动体重减轻方面有效，但人们对其在维持体重方面的长期疗效产生了一些担忧。
自1976年以来，共有1968例肥胖患者接受了胆胰转流术，其中最近连续的1217例接受了“特制胃”型转流术，其消化道支为200厘米，共同支为50厘米，胃容量在200至500毫升之间变化。平均年龄为37岁（11至69岁），平均超重117%。最长随访时间为115个月，参与率近100%。
在该系列的后半部分，手术死亡率为0.4%，无全身并发症，早期手术并发症为伤口裂开和感染（总计1.2%），晚期并发症为切口疝（8.7%）和肠梗阻（1.2%）。超重初始体重（IEW）在2年、4年、6年和8年时的平均减轻百分比，IEW高达120%的患者分别为78±16、75±16、78±18和77±16，IEW超过120%的患者分别为74±12、73±13、73±12和72±10。一组40例接受原始“对半”胆胰转流术的患者在15年随访期内，IEW平均减轻70%。特定的晚期并发症包括贫血（低于5%）、吻合口溃疡（2.8%）、蛋白质营养不良（7%，其中1.7%需要通过延长共同支或修复进行手术矫正）。短期内，骨矿物质流失引起的临床问题极少，长期来看几乎不存在。
胆胰转流术是一种非常有效的手术，但如果使用不当可能存在危险。
