Dixon John B
Head Obesity Research Unit, School of Primary Health Care, Monash University, 270 Furntree Gully Road, Notting Hill, 3168, Australia.
Obes Surg. 2009 May;19(5):641-4. doi: 10.1007/s11695-008-9765-7. Epub 2008 Nov 13.
Indications for bariatric surgery have been clear for some time and many would say that they are conservative. Unfortunately few eligible candidates seek or are referred for bariatric surgery, with less than 1% currently treated annually. In recent years, the evidence base supporting surgical therapy has strengthened with demonstrable improvements in both safety and efficacy. We now have evidence of remarkable improvements in health, quality of life, and increased life expectancy. There is continued frustration with the poor efficacy of non-surgical therapies and no indication that this is about to change. A caring physician should, as best care, refer the seriously ill morbidly obese patient for a surgical opinion. It is no different from their obligation to adequately manage type-2 diabetes, depression or unstable angina. Currently, even discussion of a surgical referral is optional. It is time we articulated and defined a group of patients where referral for a surgical opinion is no longer merely an option but a physician's responsibility as best care for the patient. It is time to provide leadership towards the delivery of better care for these patients.
一段时间以来，减肥手术的适应症已经很明确，而且很多人会说这些适应症是保守的。不幸的是，很少有符合条件的候选人寻求或被转诊进行减肥手术，目前每年接受治疗的人数不到1%。近年来，支持手术治疗的证据基础得到了加强，安全性和疗效都有了明显改善。我们现在有证据表明，健康状况、生活质量有了显著改善，预期寿命也有所延长。非手术治疗效果不佳一直令人沮丧，而且没有迹象表明这种情况即将改变。一位有爱心的医生，作为最佳治疗措施，应该将重症病态肥胖患者转诊以获得手术评估意见。这与他们妥善管理2型糖尿病、抑郁症或不稳定型心绞痛的义务没有什么不同。目前，甚至关于手术转诊的讨论都是可选项。现在是时候明确界定一类患者了，对于这类患者，转诊以获得手术评估意见不再仅仅是一种选择，而是医生作为对患者的最佳治疗措施应尽的责任。现在是时候为为这些患者提供更好的治疗发挥引领作用了。
