Kral John G, Näslund Erik
Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, NY 11203-2098, USA.
Nat Clin Pract Endocrinol Metab. 2007 Aug;3(8):574-83. doi: 10.1038/ncpendmet0563.
Obesity is very prevalent. Most treatments fail owing to hard-wired survival mechanisms, linking stress and appetite, which have become grossly maladaptive in the industrial era. Antiobesity (bariatric) surgery is a seemingly drastic, efficacious therapy for this serious disease of energy surfeit. Technical progress during the last two decades has greatly improved its safety. The surgical principles of gastric restriction and/or gastrointestinal diversion have remained largely unchanged over 40 years, although mechanisms of action have been elucidated concomitant with advances in knowledge of the molecular biology of energy balance and appetite regulation. Results of bariatric surgery in large case-series followed for at least 10 years consistently demonstrate amelioration of components of the insulin-resistance metabolic syndrome and other comorbidities, significantly improving quality of life. Furthermore, bariatric surgery has convincingly been demonstrated to reduce mortality compared with nonoperative methods. This surgery requires substantial preoperative and postoperative evaluation, teaching, and monitoring to optimize outcomes. In the absence of effective societal changes to restore a healthy energy balance, bariatric surgery is an important tool for treating a very serious disease.
肥胖非常普遍。由于将压力和食欲联系在一起的固有生存机制，大多数治疗方法都失败了，而这种机制在工业时代已变得严重适应不良。减肥（肥胖症）手术对于这种能量过剩的严重疾病而言，似乎是一种极端但有效的治疗方法。过去二十年的技术进步极大地提高了其安全性。胃限制和/或胃肠改道的手术原则在40多年里基本未变，尽管随着能量平衡和食欲调节分子生物学知识的进步，其作用机制已得到阐明。对大型病例系列进行至少10年随访的减肥手术结果一致表明，胰岛素抵抗代谢综合征的各个组成部分及其他合并症得到改善，生活质量显著提高。此外，与非手术方法相比，减肥手术已被令人信服地证明可降低死亡率。这种手术需要进行大量的术前和术后评估、指导及监测，以优化治疗效果。在缺乏有效社会变革来恢复健康能量平衡的情况下，减肥手术是治疗一种非常严重疾病的重要工具。
