Marceau P, Hould F S, Simard S, Lebel S, Bourque R A, Potvin M, Biron S
Department of Surgery, Laval Hospital, Laval University, Québec, Canada.
World J Surg. 1998 Sep;22(9):947-54. doi: 10.1007/s002689900498.
In 1990 Scopinaro's technique of biliopancreatic diversion with distal gastrectomy (DG) and gastroileostomy was modified. A sleeve gastrectomy with duodenal switch (DS) was used instead of the distal gastrectomy; and the length of the common channel was made 100 cm instead of 50 cm. A questionnaire and a prescription for blood work were sent to 252 patients who underwent DG a mean 8.3 years ago (range 6-13 years) and 465 patients who underwent DS 4.1 years ago (range 1.7-6.0 years). The questionnaire response rate was 93%, and laboratory work was completed for 65% of both groups. The mean weight loss after DG was 37 +/- 21 kg and after DS 46 +/- 20 kg. There were fewer side effects after DS: The number of daily stools was lower (p < 0.0002), as was the prevalence of diarrhea (p < 0.01), vomiting (p < 0.001), and bone pain (p < 0.001). Greater benefits related to several aspects of life were reported after DS than DG (p < 0.0001). The mean serum levels of ferritin, calcium, and vitamin A were higher (p < 0.001), and parathyroid hormone was lower. The yearly revision rate for excessive malabsorption was 1.7% per year after DG and 0.1% per year after DS. The two procedures were equally efficient for treating co-morbid conditions such as diabetes, hypertension, and hypercholesterolemia. Biliopancreatic diversion with sleeve gastrectomy/duodenal switch and a 100-cm common limb was shown to produce greater weight loss with fewer side effects.
1990年，斯科皮纳罗的胆胰转流术（BPD）联合远端胃切除术（DG）及胃回肠吻合术得到了改良。采用袖状胃切除术联合十二指肠转位术（DS）替代远端胃切除术；共同通道长度设定为100厘米而非50厘米。向平均8.3年前（范围6 - 13年）接受DG手术的252例患者以及4.1年前（范围1.7 - 6.0年）接受DS手术的465例患者发送了问卷及血液检查医嘱。问卷回复率为93%，两组均有65%完成了实验室检查。DG术后平均体重减轻37±21千克，DS术后为46±20千克。DS术后副作用更少：每日排便次数更少（p < 0.0002），腹泻（p < 0.01）、呕吐（p < 0.001）及骨痛（p < 0.001）的发生率也更低。与DG相比，DS术后在生活的多个方面报告的益处更大（p < 0.0001）。铁蛋白、钙和维生素A的平均血清水平更高（p < 0.001），甲状旁腺激素水平更低。DG术后每年因吸收不良过度的翻修率为1.7%，DS术后为0.1%。这两种手术在治疗糖尿病、高血压和高胆固醇血症等合并症方面同样有效。袖状胃切除术/十二指肠转位术联合100厘米共同肠袢的胆胰转流术显示出更大的体重减轻且副作用更少。
