Korenkov Michael, Sauerland Stefan, Junginger Theodor
Surgical Clinic, Department of Surgery, University of Mainz, Germany.
Curr Opin Gastroenterol. 2005 Nov;21(6):679-83. doi: 10.1097/01.mog.0000182859.04046.0e.
Bariatric surgery today is the only effective therapy for morbid obesity. Commonly performed procedures include adjustable gastric banding and vertical banded gastroplasty, variations of the Roux-en-Y gastric bypass, biliopancreatic diversion or duodenal switch, and mixed procedures. This review discusses key issues in the surgical management of morbid obesity.
The two most common bariatric procedures performed worldwide are laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Controversy exists regarding the best surgical procedure. Weight loss decreases according to the procedures performed in following decreasing order: biliopancreatic diversion, Roux-en-Y gastric bypass, vertical banded gastroplasty, adjustable gastric banding. Concerning the complications and quality of life, there is no single operation for morbid obesity without drawbacks. Cost-effectiveness analyses have demonstrated that bariatric surgery is cost effective at less than 50,000 US dollars/quality-adjusted life years.
According to current opinion, gastric restrictive procedures (adjustable gastric banding, vertical banded gastroplasty) are generally considered safe and quick to perform, but the long-term outcome and quality of life have been questioned. By contrast, the long-term efficacy of adjustable gastric banding can be improved by the development of new band devices. More complex bariatric procedures, such as the Roux-en-Y gastric bypass or biliopancreatic diversion, have a greater potential for serious perioperative complications but are associated with good long-term outcome in terms of weight loss combined with less dietary restriction.
如今，减肥手术是治疗病态肥胖的唯一有效疗法。常见的手术方式包括可调节胃束带术、垂直束带胃成形术、Roux-en-Y胃旁路术的变体、胆胰转流术或十二指肠转位术以及混合手术。本综述讨论病态肥胖手术治疗中的关键问题。
全球范围内最常施行的两种减肥手术是腹腔镜可调节胃束带术和腹腔镜Roux-en-Y胃旁路术。关于最佳手术方式存在争议。按施行手术方式的不同，体重减轻程度依次递减：胆胰转流术、Roux-en-Y胃旁路术、垂直束带胃成形术、可调节胃束带术。关于并发症和生活质量，没有一种治疗病态肥胖的手术不存在缺点。成本效益分析表明，减肥手术的成本效益为低于50,000美元/质量调整生命年。
根据目前的观点，胃限制性手术（可调节胃束带术、垂直束带胃成形术）通常被认为操作安全且迅速，但长期效果和生活质量受到质疑。相比之下，新型束带装置的研发可提高可调节胃束带术的长期疗效。更复杂的减肥手术，如Roux-en-Y胃旁路术或胆胰转流术，围手术期严重并发症的风险更大，但在体重减轻方面长期效果良好，且饮食限制较少。
