本帖最後由 lsc0019 於 2009-7-11 09:44 編輯
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
June 23, 2009 — 根據一項於6月號泌尿學期刊的保險數據結果顯示，Roux-en-Y胃繞道手術與術後風險增加有關。
主要作者來自馬里蘭巴爾的摩約翰霍普金斯醫學院與James Buchanan Brady泌尿學機構的Brian Matlage醫師在一場記者會中表示，我們的研究並非反對胃繞道手術，這項手術的好處並非廣為人知。相對的，我們希望幫助臨床醫師了解，接受胃繞道手術的病患可能處於腎結石的風險，這是一個可以透過預防性照護避免的狀況。
雖然胃繞道手術後經常有礦物質與電解質的異常，且增加尿道結石的風險，但是過去對胃繞道手術後結石疾病的盛行率並不清楚。這項研究的目的在於評估接受Roux-en-Y胃繞道手術後被診斷有或是接受上泌尿道結石治療的可能性。
在2002年到2006年之間，總共有4,639位未接受Roux-en-Y手術的病患，以及4,639位沒有接受手術的肥胖病患，這些病患的資料都來自國家隱私保險資料庫。所有病患都擁有超過3年以上、連續的資料。試驗的主要終點為診斷或是接受尿道結石的外科治療。
7.65%接受Roux-en-Y手術的病患被診斷有尿道結石，相較於肥胖控制組則是4.63%（215/4639）（P<0.0001）。Roux-en-Y組接受體外碎石的比例較高（81位[1.75%]相較於19位[0.41%]；P<0.0001），相較於尿道鏡（98位[2.11%]相較於27位[0.58%]；P<0.0001）。
Roux-en-Y胃繞道手術顯著地預測尿道結石（勝算比[OR]為1.71；95%信賴區間[CI]為1.44-2.04），以及接受外科泌尿道術式（OR為3.65；95% CI為2.60-5.14）。
研究作者們寫到，Roux-en-Y胃繞道手術與腎臟結石疾病、及術後階段接受腎臟結石手術風險增加有關。臨床醫師們應該小心這項風險，並告知病患這項可能的併發症。此外，需要未來的研究來評估這些高風險群族群預防性措施的好處。
這項研究的限制包括那些使用保險理賠資料庫的先天限制。
研究作者們的結論是，在這些術式後常發生的高草酸尿症是結石形成的引發因子。有鑑於肥胖目前是國家健康的重要議題，且以胃繞道手術來治療肥胖的病例快速增加，亟需未來的研究來進一步確認高草酸尿症的病因學，以及其他在此族群的結石危險因子。
Hariri家族基金會與Chad先生、Chad小姐與Nissa Richinson贊助這項研究。
Roux-En-Y Gastric Bypass Surgery Linked to Kidney Stones
By Laurie Barclay, MD
Medscape Medical News
June 23, 2009 — Roux-en-Y gastric bypass surgery is associated with an increased postoperative risk for kidney stones, according to the results of a study of insurance claims data reported in the June issue of the Journal of Urology.
"Our study is not an indictment of bariatric surgery — the benefits of this surgery are well known," lead author Brian Matlaga, MD, from the Johns Hopkins University School of Medicine and James Buchanan Brady Urological Institute in Baltimore, Maryland, said in a news release. "Rather, we'd like to help physicians understand that their bariatric patients could be at risk for kidney stones, a condition that could be avoidable with proper preventative care."
Although mineral and electrolyte abnormalities are known to follow bariatric surgery and to increase the risk for urolithiasis, the prevalence of stone disease after bariatric surgery was previously unknown. The goal of this study was to assess the probability of being diagnosed with or treated for an upper urinary tract stone after Roux-en-Y gastric bypass surgery.
From 2002 to 2006, a total of 4639 patients who underwent Roux-en-Y gastric bypass surgery and a control group of 4639 obese patients who did not have surgery were identified from a national private insurance claims database. All patients had 3 or more years of continuous claims data. The main endpoints of the study were diagnosis and surgical treatment of a urinary stone.
Urolithiasis was diagnosed in 7.65% (355/4639) of patients after Roux-en-Y gastric bypass surgery vs 4.63% (215/4639) of obese patients in the control group (P < .0001). Shock wave lithotripsy was more common in the Roux-en-Y group (81 [1.75%] vs 19 [0.41%]; P < .0001) as was ureteroscopy (98 [2.11%] vs 27 [0.58%]; P < .0001).
Roux-en-Y gastric bypass surgery significantly predicted being diagnosed with a urinary stone calculus (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.44 - 2.04) and undergoing a surgical urinary tract procedure (OR, 3.65; 95% CI, 2.60 - 5.14).
"Roux-en-Y gastric bypass surgery is associated with an increased risk of kidney stone disease and kidney stone surgery in the postoperative period," the study authors write. "Clinicians should be aware of this hazard and inform patients of this potential complication. Future studies are needed to evaluate preventive measures in the high risk population."
Limitations of this study include those inherent to the use of an administrative claims database.
"It is likely that hyperoxaluria, which has been reported to be prevalent following these surgical procedures, is one of the inciting factors in stone formation," the study authors conclude. "As obesity is currently an important national health issue and bariatric surgery to treat it is increasing at a rapid rate, further studies are urgently required to better define the etiology of hyperoxaluria as well as other stone risk factors in this population."
The Hariri Family Foundation and Mr. and Mrs. Chad and Nissa Richinson supported this study.
J Urol. 2009;181:2573-2577. |
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