腹腔镜胃旁路术后病态肥胖症患者微量营养素缺乏的诊治

目的 探讨行腹腔镜胃旁路术后病态肥胖症患者血清微量营养素的变化. 方法回顾性分析121例病态肥胖症患者腹腔镜胃旁路术后6、12、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(PTH)水平的变化.结果 本组121例病态肥胖症患者术前1个月平均体质量指数(body mass index,BMI)为(47±7)kg/m2,术后6个月平均BMI为(34±6)kg/m2,术后BMI平均下降(13±5)kg/m2(P＜0.01).在术后的2年随访中,血清Fe、Ca、Zn、Se、VitA、VitD、VitB12均在正常范围.虽然一些患者的血清Zn、Se和VitA水平偏低,但接近正常.而血清PTH始终高于正常水平,术后6、12、24个月分别升高了(22±34)pg/ml、(28±34)pg/ml、(31±40)pg/ml(P＜0.05).结论 本研究证明腹腔镜胃旁路手术治疗病态肥胖症患者是有效、安全的,但术后患者血清Ca、Zn、Se代谢及PTH水平有所改变.因此,建议所有腹腔镜胃旁路手术患者术后长期服用多种维生素和矿物质补充剂.

Micronutrients deficiencies following laparoscopic gastric bypass in patients with morbid obesity

Objective To evaluate the changes of micronutrients in patients with morbid obesity after laparoscopic Roux-en-Y gastric bypass surgery (LRYGBP). Methods We retrospectively reviewed 121 patients diagnosed with morbid obesity who underwent LRYGBP and evaluated serum Iron (Fe),calcium (Ca), zinc (Zn), selenium (Se), vitamin A (VitA), 25-hydroxy vitamin D3 (VitD), vitamin B12( VitB12 ) and parathormone (PTH) measured at 6-month, 12-month and 24-month after LRYGBP. Results A cohort of 121 patients underwent LRYGBP. The mean body mass index (BMI) before LRYGBP was (47 ±7) kg/m2. At 6 months after surgery, the mean BMI was (34 ±6) kg/m2. Postoperative mean BMI decreased significantly ( P＜ 0.01 ) 6 months after the surgery. Within the following 2 years, serum Fe, Ca,Zn, Se, VitA, VitD, VitB12 was normal. In contrast serum PTH remained continuously at a higher level than normal. Conclusions This study confirms that LRYGBP is a reliable and safe weight loss method for the patients suffering from morbid obesity. After surgery, serum Ca, Zn, Se metabolisms and PTH levels are altered in these patients. Therefore multi-vitamin and mineral supplementation are strongly recommended in all patients after LRYGBP.