Biliopancreatic diversion/duodenal switch resulted in greater weight loss than did Roux-en-Y gastric bypass in super obese patients, but it came at the expense of more frequent gastrointestinal side effects, according to a small retrospective study published online in Surgery for Obesity and Related Diseases.
Biliopancreatic diversion/duodenal switch patients also needed higher doses of vitamin supplementation and required more postoperative monitoring.
Dr. Anna Laurenius of Sahlgrenska University Hospital, Göthenburg, Sweden, and her associates tracked the outcomes at 3 years of 13 super obese patients (body mass index greater than 50 kg/m2) who had biliopancreatic diversion/duodenal switch (lap DS) and 19 patients who underwent laparoscopic Roux-en-Y gastric bypass (lap GBP). The investigators assessed changes in BMI, postoperative bowel functions, nutritional status, use of health care services, and quality of life. All patients were operated on between 2001 and 2004 and were examined in a cross-sectional study 31 months after their operations Diseases (Surg. Obes. Relat. Dis. 2010 April 8 [doi: 10.1016/j.soard.2010.03.293]).
Lap DS complications included one intestinal obstruction, one stenosis, and one stricture on the gastric tube. Complications in the lap GBP group included one ileus due to internal herniation. Three patients in the lap DS group and one patient in the lap GBP group later had a cholecystectomy, and three patients in the lap DS group were treated for clinical signs of bone disease.
Lap DS patients had significantly more weight loss than did lap GBP patients, with an average BMI loss of 25 units vs. 18 units, respectively. Lap DS patients also had significantly lower levels of hemoglobin A1c after surgery than did lap GBP patients. Average postsurgery intake was 1,100 calories greater in the lap DS group, with a mean energy intake per kilo of body weight almost double that of the lap GBP patients.
In assessing bowel function, there were no significant differences between lap DS and lap GBP patients. Both groups had significantly more gastrointestinal problems than did a Swedish norm group of 2,162 people. Although significantly more lap DS patients than lap GBP patients experienced feces incontinence or soiling, only 1 of the 12 lap DS patients said they would not recommend the procedure to someone else.
There were also no significant differences between the groups in patient satisfaction and quality of life survey scores. Lap DS patients used more health care services and had three times more outpatient visits and phone contacts with health care providers than did lap GBP patients.
The study’s authors disclosed receiving lecture fees and travel grants from Ethicon Endo Surgery.
Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
据在线发表于《肥胖症及相关病症的外科手术》上的一项小规模回顾性研究，对严重肥胖患者行胰胆分流及十二指肠转位术的减重效果较Roux-en-Y胃旁路手术更为理想，但代价是发作更为频繁的胃肠道不良反应。
行胰胆分流及十二指肠转位术的患者还需要服用更高剂量的维生素补剂，且必须接受更多的术后监测。
瑞典哥德堡萨霍琳斯加大学附属医院的Anna Laurenius博士及其同事对13例接受过胰胆分流及十二指肠转位术(lap DS)和19例接受过腹腔镜下Roux-en-Y胃旁路手术(lap GBP) 的严重肥胖患者(体重指数＞50 kg/m2) 3年时的临床转归进行了跟踪研究。研究者们对患者的体重指数(BMI)、术后肠道功能、营养状况、医疗服务的使用情况和生活质量等指标的变化情况进行了评估。所有患者的手术时间均介于2001~2004年之间，并均在术后接受了某项横向研究长达31个月的检查(Surg. Obes. Relat. Dis. 2010 April 8 [doi: 10.1016/j.soard.2010.03.293])。
lap DS的相关并发症主要包括肠梗阻、肠道狭窄和胃管狭窄。lap GBP组的并发症则主要为内部疝气造成的肠梗阻。lap DS组的3例患者和lap GBP组的1例患者之后进行了胆囊切除术，lap DS组还有3例患者因出现骨疾病的临床体征而接受了治疗。
lap DS组患者的体重减轻程度明显较lap GBP组患者多(其BMI分别平均下降了25单位和18单位)。lap DS组患者的术后血红蛋白A1c浓度明显较GBP 组患者低。lap DS组患者的术后平均能量摄入要高出1,100卡路里，其每kg体重的平均能量摄入几乎是lap GBP组患者的2倍。
在评估患者的肠道功能时，研究者发现在lap DS和lap GBP组患者之间并不存在显著差异。与另一由2,162例正常受试者组成的瑞典研究小组相比，这两组患者出现胃肠道问题的几率明显更高。尽管lap DS组患者较lap GBP患者出现大便失禁或遗粪的人数明显更多，但在出现此类症状的12例lap DS患者中仅有1人说他将不会向他人推荐该手术。
两个研究小组患者满意度和生活质量调查评分也不存在显著差异。lap DS组患者使用了更多的医疗服务，且与lap GBP组患者相比，其到门诊就诊及与医务人员电话联系的次数要多出3倍。
本研究的作者披露接受了Ethicon Endo Surgery的演讲费和差旅费补助。
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