Ursodeoxycholic Acid防止胃間隔手術後的膽結石


  Nov. 7, 2003--根據一項發表於11月Annals of Surgery的雙盲、安慰劑-控制試驗結果顯示,持續六個月每日ursodeoxycholic Acid能有效預防在胃間隔手術後形成膽結石。
  
  奧地利Krankenhaus Hallein的Karl Miller醫師和同事表示,在治療病態肥胖的手術後急速體重減輕會造成高膽結石發生率,Ursodeoxycholic Acid(600mg/d)能有效預防接受飲食-誘導體重減輕的病患形成膽結石。
  
  從1997年三月到2000年四月共262位病態肥胖的病患於單一中心接受垂直加帶胃隔間術或可調節矽膠胃束帶手術,其中有77位病患拒絕參加這項研究,而之前已接受膽結石手術或在手術前已確認有膽結石的43位病患被排除在這項研究。
  
  共有152位病患參與這項研究,隨機分配76位接受安慰劑及另外76位接收每日500mg 的ursodeoxycholic Acid,於手術後三天開始持續六個月或是直到經腹部超音波或腹部電腦斷層攝影證實有膽結石發生。
  
  兩組在性別、手術前的年齡、體重、身體質量指數及手術後體重損失是相似的,與安慰劑組比較,病患在ursodeoxycholic Acid群在12個月(3% vs. 22%; P = .0018)及24個月內(8% vs. 30%; P = .0022)有較少的膽結石形成,他們也有較低的膽囊切除比例(4.7% vs. 12%; P < .02),平均發生在肥胖手術後14 .9±4 .3個月。
  
  作者表示,肥胖病患將六個月的每日500mg劑量ursodeoxycholic Acid分成每半日服用半份的劑量能有效預防在胃間隔手術後的膽結石及避免同時產生的膽囊切除術病態,剩下的問題在於需要服用多久的ursodeoxycholic Acid及這項藥品對於長期的體重減輕的效果如何。

Ursodeoxycholic Acid Prevents<

By Laurie Barclay, MD
Medscape Medical News

Nov. 7, 2003 — Daily ursodeoxycholic acid for six months was effective prophylaxis against gallstone formation after gastric restrictive procedures, according to the results of a randomized, double-blind, placebo-controlled trial published in the November issue of the Annals of Surgery.

"Rapid weight loss after surgery for the treatment of morbid obesity is associated with a high incidence of gallstone formation," write Karl Miller, MD, from Krankenhaus Hallein in Austria, and colleagues. "Ursodeoxycholic acid (600 mg/d) is highly effective in preventing gallstone formation in patients undergoing dietary-induced weight reduction."

From March 1997 to April 2000, 262 patients with morbid obesity had vertical banded gastroplasty or adjustable gastric banding at a single-center. Of these, 77 patients refused to participate in the study, and 43 patients with previous gallstone operation or gallstones verified preoperatively were excluded.

Of 152 patients enrolled in the study, 76 were randomized to placebo and 76 to 500 mg of ursodeoxycholic acid daily, beginning within three days after surgery and continuing for six months or until gallstone development was documented on transabdominal sonography or abdominal computed tomography.

Both groups were similar in sex, preoperative age, weight, and body mass index, and in postoperative weight loss. Compared with the placebo group, patients in the ursodeoxycholic acid group had less gallstone formation at 12 months (3% vs. 22%; P = .0018) and at 24 months (8% vs. 30%; P = .0022). They also had lower rates of cholecystectomy (4.7% vs. 12%; P < .02), which was performed an average of 14.9 ± 4.3 months after bariatric surgery.

"A daily dose of 500 mg of ursodeoxycholic acid in divided doses semi-daily for six months is an effective prophylaxis for gallstone formation after gastric restrictive procedures and avoids simultaneous cholecystectomy in morbidly obese patients," the authors write. "The question remains of how long ursodeoxycholic acid should be taken and how effective this drug is in long-term weight loss."

Ann Surg. 2003;238: 697-702

Reviewed by Gary D. Vogin, MD

    
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