Hocking M P, Davis G L, Franzini D A, Woodward E R
Department of Surgery, University of Florida College of Medicine, Gainesville 32608, USA.
Dig Dis Sci. 1998 Nov;43(11):2493-9. doi: 10.1023/a:1026698602714.
This study assesses the long-term results of jejunoileal bypass (JIB) in 43 prospectively followed patients whose surgical bypass remained intact. Follow-up was 12.6+/-0.25 years from JIB. Weight loss and improved lipid levels, glucose tolerance, cardiac function, and pulmonary function were maintained. Adverse effects such as hypokalemia, cholelithiasis, and B12 or folate deficiency decreased over time. The incidence of diarrhea remained constant (63% vs 64% at five years), while the occurrence of hypomagnesemia increased (67% vs 43% at five years, P < 0.05). Nephrolithiasis occurred in 33% of patients. Hepatic fibrosis developed in 38% of patients and was progressive. Overall, after more than 10 years, 35% of patients appeared to benefit from JIB as defined by alleviation of preoperative symptoms and the development of only mild complications (vs 47% at five years). On the other hand, irreversible complications appeared to outweigh any benefit derived from the JIB in 19% (vs no patients at five years; P < 0.01). In summary, patients with JIB remain at risk for complications, particularly hepatic fibrosis, even into the late postoperative period.
本研究评估了43例接受空肠回肠旁路术（JIB）且手术旁路保持完整的前瞻性随访患者的长期结果。自JIB术后的随访时间为12.6±0.25年。体重减轻以及脂质水平、糖耐量、心功能和肺功能的改善得以维持。低钾血症、胆石症以及维生素B12或叶酸缺乏等不良反应随时间减少。腹泻发生率保持不变（五年时为63%对64%），而低镁血症的发生率增加（五年时为67%对43%，P<0.05）。33%的患者发生肾结石。38%的患者出现进行性肝纤维化。总体而言，超过10年后，35%的患者似乎从JIB中获益，定义为术前症状缓解且仅出现轻度并发症（五年时为47%）。另一方面，19%的患者出现的不可逆并发症似乎超过了JIB带来的任何益处（五年时无患者出现；P<0.01）。总之，即使到术后晚期，接受JIB的患者仍有发生并发症的风险，尤其是肝纤维化。
