胆胰分流并十二指肠转位术治疗胃袖状切除术后复胖个案报告并文献复习

目的:探讨胆胰分流并十二指肠转位术作为胃袖状切除术后复胖修正手术的可行性。方法:女性患者,重度肥胖,身体质量指数(BMI)为42.3 kg/m^2,合并2型糖尿病,应用胰岛素治疗血糖控制不佳,糖化血红蛋白(HbA1c)10.5%;首次接受腹腔镜胃袖状切除术,术后1年BMI降至32.4 kg/m^2,HbA1c 8.9%;术后3年,BMI反弹至40.2 kg/m^2,HbA1c为10%。再次接受标准的胆胰分流并十二指肠转位术,即食物肠袢150 cm、共同肠袢100 cm。结果:胆胰分流并十二指肠转位术术后3个月,BMI 39.9 kg/m^2,HbA1c 8.9%,恢复正常进食,排便次数3~4次/d,质软,无特殊不适。结论:胆胰分流并十二指肠转位术作为腹腔镜胃袖状切除术的术后修正手术,对于体重反弹、血糖增高的治疗效果优异,且不影响患者进食习惯,但术后营养并发症较多见,需密切关注。

Biliopancreatic diversion with duodenal switch for the treatment of weight regain after sleeve gastrectomy:a case report and literature review

Objective:To explore the feasibility of biliopancreatic diversion with duodenal switch(BPD/DS)as a revisional surgery after sleeve gastrectomy(SG)due to weight regain.Methods:A female patient with body mass index(BMI)of 42.3kg/m^2,was diagnosed with severe obesity and type 2 diabetes mellitus.Plasma glucose level was not well controlled even with administration of insulin.Hemoglobin A1c(HbA1c)level was 10.5%.A primary laparoscopic SG was performed.One year later,BMI was down to 32.4kg/m^2 and HbA1c was 8.9%.Three years after SG,BMI rebounded up to 40.2 kg/m^2 and HbA1c was 10%.A standard BPD/DS procedure was performed as revisional surgery with an alimentary limb of 150 cm and common channel 100 cm.Results:Three months after revisional BPD/DS,BMI was down to 39.9 kg/m^2 and HbA1c 8.9%.The patient returned back to normal diet with 3-4 times bowel movements each day,and without other discomforts.Conclusions:As a revisional surgery after SG,BPD/DS is effective in amelioration of weight regain and diabetes relapse without affecting established dietary behaviors.However,malnutrition complication is more frequent than other bariatric procedures,and needs to be closely monitored.