Bariatric surgery proves long-term benefit in patients with cirrhosis  

减重手术可使肝硬化患者长期受益

作　　者：Manhal Izzy Mounika Angirekula Barham KAbu Dayyeh Fateh Bazerbachi Kymberly D.Watt 

机构地区：[1]Division of Gastroenterology,Hepatology,and Nutrition,Vanderbilt University Medical Center,Nashville,TN,USA [2]Division of Gastroenterology and Hepatology,Mayo Clinic and Foundation,Rochester,MN,USA [3]Division of Gastroenterology,Massachusetts General Hospital,Boston,MA,USA

出　　处：《Gastroenterology Report》2021年第3期252-256,I0002,共6页胃肠病学报道（英文）

摘　　要：Background:Obesity is commonly observed in patients with cirrhosis,especially with the increasing prevalence of nonalcoholic steatohepatitis(NASH).Bariatric surgery has been avoided in these patients given concerns about increased perioperative risk;therefore,data are lacking regarding long-term outcomes.In this study,we aimed to evaluate the long-term outcomes of patients with cirrhosis who underwent bariatric surgery.Methods:We reviewed the charts of adult patients with compensated cirrhosis who underwent bariatric surgery after they were prospectively enrolled between February 23,2009 and November 9,2011,and followed in a pilot study for evaluation of bariatric surgery outcomes.Only patients with more than 4 years of follow-up were included in the analysis.Data regarding their liver disease,metabolic status,and survival were collected.A descriptive analysis was performed.Results:The cohort consisted of 10 patients,of whom 7 were females.The median post-surgical follow-up was 8.7 years(61.4 years).All patients had biopsy-proven NASH;two patients had concurrent,untreated hepatitis C infection.During the observation period,there was a mean weight loss of 24 kg(19.2%of total body weight pre surgery,P<0.001)and only one patient regained weight to the baseline pre-surgical measurement.One patient who was not eligible for transplant developed hepatic encephalopathy 3 years after surgery and later died.The remainder of the patients did not have any hepatic decompensation,cardiovascular event,or mortality.Except for one patient with Gilbert syndrome,bilirubin was normal in all patients at last follow-up.Conclusions:Bariatric surgery in patients with compensated cirrhosis can lead to sustained weight loss and stable hepatic function on long-termfollow-up.背景:肥胖常见于肝硬化患者,特别是非酒精性脂肪性肝炎(NASH)越来越流行之后。考虑到较高的围手术期风险,临床上会尽量避免对这些患者进行减重手术,因此,其长期疗效的数据仍然缺乏。本研究旨在评估减重手术对肝硬化患者中的长期疗效。方法:我们对2009年2月23日至2011年11月9日间开展的一项初步研究的病例资料进行回顾性分析,包括肝病情况、代谢状态及生存结果。该研究前瞻性地纳入接受减肥手术的代偿性肝硬化成人患者并对其进行随访。本研究对其中随访记录超过4年的患者进行描述性分析,以评估减肥手术的长期疗效。结果:全组共10例患者,其中女性7例。术后平均随访时间8.7-1.4年。所有患者均患有病理证实的NASH;2位患者并发未经治疗的丙型肝炎。随访期间,患者体重平均下降24 kg(相对于术前体重下降19.2%,P<0.001),仅1例患者重回术前水平。1例不宜肝移植的患者术后3年发生肝性脑病,随即去世;其余9例患者未发生肝性脑病、心血管事件或死亡。末次随访时,除1例吉尔伯特综合征患者之外,其余8例胆红素水平均在正常范围内。结论:减肥手术应用于使代偿性肝硬化患者,不仅可获得长期的减重效果,而且能保持稳定的肝功能。

关 键 词：OBESITY weight loss bariatric surgery CIRRHOSIS non-alcoholic steatohepatitis 

分 类 号：R575.2[医药卫生—消化系统]