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首页> 外文期刊>Current treatment options in gastroenterology >Prevention or Surgical Treatment of Gallstones in Patients Undergoing Gastric Bypass Surgery for Obesity.
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Prevention or Surgical Treatment of Gallstones in Patients Undergoing Gastric Bypass Surgery for Obesity.

机译：肥胖的胃旁路手术患者的胆结石的预防或外科治疗。

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It is well known that obesity is a risk for gallstone formation and biliary sludge. Additionally, it has been clearly shown that rapid weight loss following bariatric surgery is a risk factor for cholesterol cholelithiasis. Multiple serious complications from gallstones such as cholecystitis, cholangitis, gallstone pancreatitis, and cholecystenteric fistulae may occur. Thus, it is necessary to employ medical or surgical methods to prevent or treat gallstones in this group. Therapy should be individualized. Although there is a high incidence of gallstones in this group, only a minority of individuals will develop symptomatic disease. When used in patients who are compliant, ursodeoxycholic acid therapy can be effective to prevent gallstone formation during rapid weight loss. The cost effectiveness of routine ursodeoxycholic acid therapy compared with the potential costs of complicated gallstone disease needs to be further investigated. Combined cholecystectomy with Roux-en-Y gastric bypass surgery is a safe and appropriate therapeutic option in those with preoperatively known gallstones, biliary sludge, and prior episodes of cholecystitis. However, routine cholecystectomy at the time of gastric bypass surgery is not warranted for all patients because of the increased time of operation and postoperative hospitalization, as well as all the potential complications after cholecystectomy. The approach of routine cholecystectomy in this setting subjects many patients to an unnecessary procedure because the majority will not develop symptoms or complications of gallstones. Furthermore, cholecystectomy is technically easier to perform after weight loss occurs.
机译：众所周知，肥胖是胆结石形成和胆汁淤泥的风险。另外，已经清楚地表明，减肥手术后的快速体重减轻是胆固醇胆石症的危险因素。胆结石可能会导致多种严重的并发症，例如胆囊炎，胆管炎，胆结石胰腺炎和胆囊性肠瘘。因此，有必要采用医学或外科方法来预防或治疗这一组的胆结石。治疗应个体化。尽管该组胆结石的发生率很高，但只有少数个体会发展为症状性疾病。当用于顺应性患者时，熊去氧胆酸治疗可有效防止快速减肥期间形成胆结石。常规熊去氧胆酸治疗的成本效益与复杂胆结石疾病的潜在成本相比，还需要进一步研究。胆囊切除术与Roux-en-Y胃搭桥手术相结合是术前已知胆结石，胆汁淤积和先前发生胆囊炎的患者的一种安全，适当的治疗选择。然而，由于手术时间和术后住院时间增加，以及所有胆囊切除术后潜在的并发症，并非所有患者都应在胃旁路手术时进行常规胆囊切除术。在这种情况下，常规胆囊切除术会使许多患者接受不必要的手术，因为大多数患者不会出现胆结石的症状或并发症。此外，减轻体重后胆囊切除术在技术上更容易执行。

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