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91.
Background: Vitamin B12 deficiency after gastric surgery for obesity is due to a failure of separation of vitamin B12 from protein foodstuffs and to a failure of absorption of crystalline vitamin B12 in the presence of intrinsic factor. The purpose of this study was to determine which of four oral doses of crystalline vitamin
B12 was most effective in treating vitamin B12 deficiency in 102 patients. Methods and Results: At time of entry into the study, the patients had a serum vitamin B12 < 100 pmol L −1, were 29.9 ± 21.7 months post-op, were 37 ± 8 years old and had a body mass index of 30 ± 6 kg m−2. Eight (8%) had had a vertical banded gastroplasty and 94 (92%) a gastric bypass. For the first 3 months all patients received
350 μg per day of crystalline vitamin B12 and all increased their serum vitamin B12 levels to over 100 pmol L−1. The patients were then assigned to receive for a further 3 month period one of four oral doses of crystalline vitamin B12-100 μg, 250 μg, 350 μg and 600 μg. Serum vitamin B12 levels were greater than 150 pmol L−1 after 6 months in 83.3% of patients who received 100 μg; 92.3% of patients who received 250 μg; 94.7% after 350 μg and 95.2%
after 600 μg (p%0.525). Conclusion: At least 350 μg per day is the appropriate oral dose of crystalline vitamin B12 after gastric surgery for obesity to correct low serum vitamin B12 levels in 95% of patients. 相似文献
92.
Background: This study explored eating habits, nutrient intake, and blood vitamin and mineral levels to determine whether
severely obese subjects (BMI 40-50 kg m−2) post-vertical banded gastroplasty (VBG) or gastric bypass Roux-en-Y (GBR) are at risk of developing compounded under-nutrition.
Methods: A dietary follow-up of 36 VBG and 19 GBR was maintained for 18 months via 7-day food intake diaries and 24-h recalls.
Food intake was analysed for energy and nutrient composition and for its relative amount to recommended dietary allowances
(RDA). Results: Weight loss was greatest during the first 6 months, continued at a slower rate for the next 6 months, nearly
ceasing thereafter. The results following GBR were not substantially different from those following VBG 18 months postoperatively.
The median weight loss at 1 year postoperatively was 48, 46, 48 and 36 kg; expressed as residual excess body weight: 0.2,
16, 13 and 22% for GBR Men, Women, VBG Men, Women, respectively. According to the classification proposed by Reinhold, all
subjects achieved excellent treatment outcomes 18 months postoperatively. Despite the relatively low reported energy intake
(20-50% below RDA), no correlation was found between rate of weight loss and energy intake at 6 months postoperatively. The
intake of most vitamins and minerals was below 50% of RDA during the 18 months follow-up. The increase in energy intake did
not improve the level of the nonenergy-contributing nutrients. Compliance to multivitamin and mineral supplement intake deteriorated
with time. Conclusion: The low to within-normal range of blood vitamin and mineral levels 12 months postoperatively suggests
the slow development of subclinical nutritional deficiency which could jeopardize the subjects' long-term health status. 相似文献
93.
94.
目的探讨胃癌病人手术前后免疫状态变化及其意义。方法分别对术前及术后1、2、3、4周胃癌病人外周血T细胞亚群、NK细胞活性以及IgG、IgA进行检测,以健康体检者作为对照。结果胃癌病人术前CD3 、CD4 、CD4 /CD8 之值及NK细胞活性均显著低于正常对照组(P<0.01),CD8 显著高于正常对照组(P<0.01)。术后1周CD3 、CD4 、CD8 、NK细胞活性均降低,切除组术后2周开始CD3 、CD4 、CD4 /CD8 之值及NK细胞活性出现攀升,术后3周之水平已超过术前,术后4周基本接近正常;而未切除组则无明显变化。胃癌病人术前IgG、IgA水平较正常对照组为高,术后1周尤甚(P<0.01),切除组在术后2周开始下降,3周后基本正常;未切除组则仍维持较高水平。结论胃癌病人的细胞免疫功能处于抑制状态。手术切除原发癌瘤,尽管部分患者未能达到根治目的,也能使荷瘤机体免疫抑制状态得到缓解。术后1周内所表现的细胞免疫功能几近衰竭,可能造成癌瘤的扩散和转移,强调手术前后应对病人的免疫状态加以保护。 相似文献
95.
Finger bougie method compared with pyloroplasty in the gastric replacement of the esophagus 总被引:2,自引:0,他引:2
Yamashita Y Hirai T Mukaida H Yoshimoto A Kuwahara M Inoue H Toge T 《Surgery today》1999,29(2):107-110
To elucidate the necessity of pyloroplasty for the gastric tube through the posterior mediastinum in esophageal surgery, gastric
emptying and duodenogastric reflux (DGR) were evaluated in 16 cases undergoing an anterior pylorectomy (group P) and in 16
cases treated by the finger bougie method (group F). First, the obstruction and reflux symptoms were examined based on a patient
questionnaire using a brief scoring system. The median value of the symptom score showed the patients in P to have more symptoms
than those in F; however, the difference was not significant (8.0 vs 6.0). Secondly, the swallowed Tc O4
− (85 MBq) was counted using a gamma camera at three sites on the sternal bone in the upright position based on a gastric transit
scintigram. Both the descending time of the RI peak and the clearance rates were similar between the two groups. Thirdly,
intragastric 24-h pH monitoring was carried out. Antimony pH sensors were anchored 5 and 15 cm below the esophagogastrostomy.
We could not find any difference between the two groups in both the % time pH>4 and %time pH>7. These findings thus revealed
no big difference between groups P and F. The finger bougie method to drain the vagotomized posterior mediastinal stomach
was found to achieve results similar to conventional pyloroplasty, while it was also simpler and safer. 相似文献
96.
We report herein the case of a 32-year-old woman who underwent distal gastrectomy with D2 lymph node dissection for gastric
cancer. Microscopic examination of the resected specimen revealed signet-ring cell carcinoma of the stomach with lymph node
metastases, and endosalpingiosis in the normal lymph nodes. There was no evidence of malignancy in the peritoneal cavity.
To our knowledge, no other case of endosalpingiosis in the lymph nodes along the stomach has ever been reported. The possible
significance of endosalpingiosis is discussed following this case report. 相似文献
97.
Background: The complications of the gastric pouch in gastric bypass surgery are well known. Since the first report of this
surgery 30 years ago, new technical aspects that make it safer and more effective have been implemented. Methods: As a modification
of gastric bypass, the authors have performed 305 vertical banded gastroplasty-gastric bypass procedures. Two groups of patients
underwent the procedure: Group I (n = 206) without a limb of jejunum interposed between the gastric pouch and the excluded
stomach, and Group II (n = 99) with a limb of jejunum interposed between the pouch and the stomach. The results regarding
excess weight loss and complications of the gastric pouch during the first year after surgery were compared. Results: Age,
sex, initial weight, body mass index, and percentage of ideal weight were similar in both groups. Excess weight loss was also
similar. The complications in Group I were 1 leak, 3 left subphrenic abscesses, 2 erosive gastritis with bleeding, 1 stenosis
of the gastrojejunostomy, 1 perforated ulcer, and 4 marginal ulcers with bleeding. Two patients in Group II developed bleeding
from the staple-line. Conclusions: These preliminary data suggest that complications of the gastric pouch can be reduced by
interposing a limb of jejunum between the pouch and the excluded stomach. This is an early experience; long-term results are
pending. 相似文献
98.
99.
Gastro-Gastric Fistulas and Marginal Ulcers in Gastric Bypass Procedures for Weight Reduction 总被引:7,自引:5,他引:2
Background: Gastro-gastric fistulas and marginal ulcers are frequent and serious complications of gastric compartmentalization
procedures for obesity. Methods: The authors analyzed 810 patients after 911 operations for gastro-gastric fistulas and marginal
ulcers over an 8-year period. All patients underwent a form of gastric bypass, in which a pouch is constructed along the lesser
curvature of the stomach. The outlet of the pouch was restricted with a prosthetic band. In the first 189 patients (Group
I), the pouch and stomach were stapled in continuity or partially divided. In the next 222 patients (Group II), segments were
stapled and separated by transection. In the remaining 492 cases (Group III), in addition to transection of the stomach, a
limb of jejunum was interposed between the pouch and excluded stomach. Stapled anastomoses were done in Group I and II patients
and a portion of Group III patients. The remaining patients underwent hand-sewn anastomosis. Results: Gastro-gastric fistulas
occurred in 49% of the patients in Group I, 2.6% of those in Group II, and 0% of those in Group III. In stapled anastomosis,
the incidence of marginal ulceration in Groups I, II, and III were 8.5%, 5.4%, and 5.1%, respectively. In a subset of Group
III patients, in whom a two-layer, hand-sewn anastomosis was done, the incidence was 1.6% when the outer layer was not absorbable
and 0% when both layers were absorbable. Conclusions: Gastro-gastric fistulas and marginal ulcerations are likely the result
of breakdown of the mucosa resulting from migrating staples and other foreign material. Lack of integrity of the gastric lining
facilitates the action of the gastric digestive process. Transection of gastric segments with interposition of jejunum prevents
gastro-gastric fistula formation. An intact serosa appears to block the digestion of bowel wall by gastric enzymes. Our early
data suggest that the use of absorbable sutures at the gastrojejunostomy significantly decreases the incidence of marginal
ulceration. 相似文献
100.
Success Habits of Long-Term Gastric Bypass Patients 总被引:1,自引:1,他引:0
Background: By identifying common habits of the most successful long-term gastric bypass patients, one is able to establish
more specific guidelines for new patients to follow. The first postoperative year is a critical time that must be dedicated
to changing old behavior and forming new, lifelong habits. Methods: 100 gastric bypass patients from 1979 to 1995 participated
in a comprehensive survey. Surveys were completed in person, by phone, or in writing. Participants were asked to answer questions
regarding their eating, drinking, sleeping, exercise, and personal habits. Results: The survey revealed that specific habits
are common in gastric bypass patients who have maintained their weight loss for many years. Conclusion: Identifying and defining
the common habits of patients who are successful with long-term weight loss enabled specific guidelines to be established
for new patients to implement during the initial weight loss phase, which will contribute to life-long success. 相似文献