The management of patients with vitamin B12 deficiency after total gastrectomy (TG) remains controversial. We aimed to evaluate the effect of vitamin B12 replacement intervals on the clinical characteristics in these patients. The data from patients who received vitamin B12 supplementation after TG between 2007 and 2018 at the National Cancer Center, Korea, were retrospectively evaluated. Vitamin B12 deficiency was defined as a serum vitamin B12 level of <200 pg/mL or urine methylmalonic acid level > 3.8 mg/gCr. The patients were divided into a regular replacement group (patients received an intramuscular injection or oral medication regularly), and a lab-based replacement group (patients received vitamin B12 intermittently after checking the level). The symptoms and biochemical parameters were compared between these groups. The regular and lab-based replacement groups included 190 and 216 patients, respectively. The median vitamin B12 replacement intervals were 1 and 9 months, respectively (p< 0.001). After replacement, the regular replacement group had higher vitamin B12 levels than the lab-based replacement group (p< 0.001). However, the serum hemoglobin level showed no significant changes. After replacement, there was no significant difference in the proportion of the symptomatic patients between the groups. Replacing vitamin B12 with a lab-based protocol may be sufficient for TG patients.
全胃切除术后维生素B12缺乏症患者的管理策略仍存争议。本研究旨在评估不同维生素B12补充间隔对患者临床特征的影响。我们回顾性分析了2007年至2018年间在韩国国立癌症中心接受全胃切除术后补充维生素B12的患者数据。维生素B12缺乏定义为血清维生素B12水平<200 pg/mL或尿甲基丙二酸水平>3.8 mg/gCr。将患者分为规律补充组（定期接受肌肉注射或口服药物）和实验室指导补充组（根据检测水平间歇性补充）。比较两组患者的症状和生化指标。规律补充组和实验室指导补充组分别纳入190例和216例患者，中位补充间隔分别为1个月和9个月（p<0.001）。补充治疗后，规律补充组的维生素B12水平显著高于实验室指导补充组（p<0.001），但两组血清血红蛋白水平未见显著变化。治疗后两组有症状患者比例无统计学差异。对于全胃切除术后患者，采用实验室指导的维生素B12补充方案可能已足够。
肿瘤(癌症)患者之家