Scopinaro N, Adami G F, Marinari G M, Gianetta E, Traverso E, Friedman D, Camerini G, Baschieri G, Simonelli A
Department of Surgery, University of Genoa School of Medicine, Italy.
World J Surg. 1998 Sep;22(9):936-46. doi: 10.1007/s002689900497.
Biliopancreatic diversion (BPD) has made reacceptable the malabsorptive approach to the surgical treatment of obesity. The procedure, in a series of 2241 patients operated on during a 21-year period, caused a mean permanent reduction of about 75% of the initial excess weight. The indefinite weight maintenance appears to be due to the existence of a threshold absorption capacity for fat and starch, and thus energy, and the weight loss is partly due to increased resting energy expenditure. Beneficial effects other than those consequent to weight loss or reduced nutrient absorption included permanent normalization of serum glucose and cholesterol without any medication and on totally free diet in 100% of cases, both phenomena being due to a specific action of the operation. Operative mortality was less than 0.5%. Specific late complications included anemia, less than 5% with adequate iron or folate supplementation (or both); stomal ulcer, reduced to 3.2% by oral H2-blocker prophylaxis; bone demineralization, increasing up to the fourth year and tending to decrease thereafter, with need of calcium and vitamin D supplementation; neurologic complications, totally avoidable by prompt vitamin B administration to patients at risk; protein malnutrition, which was reduced to a minimum of 3% with 1.3% recurrence, in exchange with a smaller weight loss, by adapting the volume of the gastric remnant and the length of the alimentary limb to the patient's individual characteristics. It is concluded that the correct use of BPD, based on the knowledge of its mechanisms of action, can make the procedure an effective, safe one in all hands.
胆胰转流术（BPD）使肥胖症手术治疗中的吸收不良方法再次被接受。在21年期间对2241例患者进行的该手术，使初始超重体重平均永久性减轻约75%。体重的持续维持似乎归因于脂肪和淀粉以及能量存在吸收能力阈值，体重减轻部分归因于静息能量消耗增加。除了体重减轻或营养吸收减少带来的益处外，该手术的有益效果还包括在无需任何药物治疗且完全自由饮食的情况下，100%的患者血清葡萄糖和胆固醇永久性恢复正常，这两种现象均归因于手术的特定作用。手术死亡率低于0.5%。特定的晚期并发症包括贫血，补充足够的铁或叶酸（或两者）后发生率低于5%；吻合口溃疡，通过口服H2受体阻滞剂预防后降至3.2%；骨质脱矿，在术后第四年加重，此后趋于减轻，需要补充钙和维生素D；神经并发症，对有风险的患者及时给予维生素B可完全避免；蛋白质营养不良，通过根据患者个体特征调整胃残端容积和消化道肢体长度，将其降至最低3%，复发率为1.3%，但体重减轻幅度较小。结论是，基于对其作用机制的了解正确使用BPD，可使该手术在所有医生手中都成为一种有效、安全的手术。
