121例腹腔镜Roux-en-Y胃空肠吻合术后随访结果

Laparoscopic Roux-en-Y gastric bypass for morbid obesity:Follow-up results in 121 patients

目的探讨腹腔镜Roux-en-Y胃空肠吻合术（laparoscopic Roux-en-Y gastric bypass，LRYGBP）治疗病态肥胖的术后营养和代谢方面的变化。方法121例LRYGBP，男40例，女81例。分别测定术前1个月及术后6个月的体重指数（body mass index，BMI）。对比分析6个月、12个月，24个月血清铁（Fe）、钙（Ca）、锌（Zn）、硒（Se）及维生素A（VitA）、维生素D（VitD）、维生素B12（VitB12）和甲状旁腺素（parathyroid hormone，PTH）的水平变化。结果术前1个月BMI（47．00±7．15）kg／m^2，术后6个月BMI（33．79±6．06）kg／m^2，BMI下降（13．21±5．47）kg／m^2（t=26．103，P=0．000）。术后血清Fe、Ca、Zn、Se及ViLA、VitD、VitB12均在正常范围，其中术后6个月血清Zn、Se和VitA水平虽然在正常范围内，但分别有19．5％（17／87）、22．7％（20／88）和33．7％（28／83）的患者低于正常水平，但术后2年仅有6．7％（2／30）、11．5％（3／26）和17．2％（5／29）的患者低于正常水平。血清PTH术后6个月11～161pg／ml，（66±34）pg／ml、1年24～154pg／ml，（72±34）pg／ml、2年21～194pg／ml，（75±40）pg／ml（正常值9～44pg／ml）。结论LRYGBP治疗病态肥胖是有效、安全的。术后2年血清Fe、Ca及VitD、VitB12均正常；血清锌、硒及维生素A经术后6个月给予补充剂大多接近正常；血清PTH水平明显高于正常。建议患者术后长期服用复合维生素、矿物质补充剂，定期到医院随访。

Objective To summarize the changes of nutrition and metabolism after laparoscopic Roux-en-Y gastric bypass surgery （LRYGBP） in the treatment of morbid obesity. Methods LRYGBP was performed in 121 patients with morbid obesity （ male, 40 patients; femal, 81 patients）. The body mass index （BMI） was measured 1 month before and 6 months after the operation. A comparative analysis was conducted on serum levels of ferrum （Fe） , calcium （Ca） , zincum （Zn） , selenium （ Se ） , vitamin A （VitA）, vitamin D （VitD）, vitamin Bt2 （VitB12）, and parathyroid hormone （PTH） at 6, 12, and 24 months after operation. Results The BMI was declined from 47.00 ±7.15 kg/m^2 preoperatively to 33.79 ± 6.06 kg/m^2 postoperatively, with a decrease of 0.26 -42.58 kg/m2 （ 13.21 ± 5.47 kg/m^2 ） （t = 26. 103, P = 0. 001 ）. The postoperative serum levels of Fe, Ca, Zn, Se, VitA, VitD, and VitB12 were all within the normal limits. However, the levels of Zn, Se, and VitA were lower than the normal in 19.5% （17/87）, 22.7% （20/88）, and 3.7% （28/83） of patients at 6 months after operation, and in 6.0% （2/30）, 11.5% （3/26）, and 17.2% （5/29） of patients at 2 years after operation, respectively. The serum PTH levels were 11 - 161 pg/ml （66 ± 34 pg/ml）, 24-154 pg/ml （72 ± 34 pg/ml） , and 21 - 194 pg/ml （75 ±40 pg/ml） at 6, 12, and 24 months after operation, respectively （normal limits, 9 -44 pg/ml ）. Conclusions Laparoscopic Roux-en-Y gastric bypass surgery is a reliable and safe option for patients with morbid obesity. The serum levels of calcium, zinc, selenium, and PTH will be influenced following the surgery. Supplementation of multi-vitamins and mineral substances should be strongly advised in all patients.