袖式胃切除术后营养缺乏:综合文献综述

Sameh Hany Emile, H. Elfeki
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引用次数: 13

摘要

袖式胃切除术(SG)已被认为是治疗病态肥胖和相关合并症的有效方法;然而,SG的缺点,如钉线泄漏、出血、呕吐和体重反弹,也有很多报道。一个被低估的副作用是营养缺乏(ND)。虽然ND是众所周知的吸收不良减肥手术并发症,但它仍然可以在限制性手术后发生,包括SG,但其发病率和机制尚不清楚。为了了解SG后ND的发生率和类型,我们对电子数据库进行了有组织的文献检索,检索评估SG后ND的发生率和类型的文章。SG后缺铁和缺锌的中位发生率分别为8.8%和18.8%。大多数患者术前已经存在维生素D缺乏症,中位数为35.5%的患者术后仍表现出维生素D缺乏症。SG前后比较ND,术后铁和维生素D缺乏症发生率下降;相反,维生素B1、B6、B12和钙缺乏症的发生率明显增加。维生素B1和B12缺乏症分别记录在中位数10.0%和11.7%的患者中,并且在<1%的患者中伴有神经系统症状。SG术后ND的预防需要术前正确识别和纠正ND,术后立即补充微量元素和维生素,并进行长时间随访。
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Nutritional Deficiency After Sleeve Gastrectomy: A Comprehensive Literature Review
Sleeve gastrectomy (SG) has been recognised as an effective procedure for the treatment of morbid obesity and associated comorbidities; however, the shortcomings of SG, such as staple line leak, haemorrhage, vomiting, and weight regain, have also been well-reported. An underestimated adverse effect of SG is nutritional deficiency (ND). While ND is a well-known complication of malabsorptive bariatric procedures, it can still occur after restrictive operations, including SG, yet its incidence and mechanism are still unclear. In an attempt to learn about the incidence and type of ND after SG we performed an organised literature search of electronic databases searching for articles that assessed the incidence and type of ND after SG. The median incidence of iron and zinc deficiency after SG was 8.8% and 18.8%, respectively. The majority of patients already had vitamin D deficiency preoperatively, with a median of 35.5% of patients still demonstrating vitamin D deficiency postoperatively. Comparing ND before and after SG, the incidence of iron and vitamin D deficiency declined postoperatively; in contrast, there was a tangible increase in the incidence of vitamin B1, B6, B12, and calcium deficiency. Vitamin B1 and B12 deficiencies were recorded in a median of 10.0% and 11.7% of patients, respectively, and were associated with neurologic manifestations in <1% of patients. Prevention of ND after SG requires proper recognition and correction of preoperative ND with immediate supplementation of trace elements and vitamins postoperatively, in addition to long follow-up.
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