Abeles Deborah, Shikora Scott A
Department of Surgery, Center for Minimally Invasive Obesity Surgery, Tufts-New England Medical Center, Boston, MA 02111, USA.
Aesthet Surg J. 2008 Jan-Feb;28(1):79-84. doi: 10.1016/j.asj.2007.09.007.
The increasing use of bariatric procedures in the treatment of morbidly obese patients means that aesthetic plastic surgeons can expect to care for more and more patients who have undergone bariatric surgery. It is important for aesthetic surgeons to understand the procedures, outcomes, and possible complications to recognize the signs and symptoms of any potential problems. Candidates for bariatric surgery must have a body mass index (BMI) of at least 40 kg/m(2) or a BMI of 35 kg/m(2) with at least one comorbidity, plus demonstrated failure of nonsurgical means of weight control to control weight and no significant psychiatric disorders. Surgical procedures can be categorized as restrictive or malabsorptive and include adjustable gastric band, Roux-en-Y gastric bypass, and biliopancreatic diversion with or without duodenal switch. There are no definitive criteria for choosing any single procedure, although in general restrictive procedures may be more appropriate for those patients with lower BMIs and malabsorptive procedures for those with higher BMIs. Results of bariatric surgery are impressive and include not only significant and sustained weight loss but also improvement or resolution of major comorbid conditions. Significant complications include anastomotic leak, marginal ulceration, and internal herniation, as well as wound infection, incisional hernia, hemorrhage, deep venous thrombosis, and pulmonary embolus. Innovative procedures now under study include gastrointestinal neuromodulation, sleeve gastrectomy, intragastric balloons, intraluminal sleeves, and other endoscopic procedures.
减肥手术在治疗病态肥胖患者中的应用日益增加，这意味着美容整形外科医生将会护理越来越多接受过减肥手术的患者。对于美容外科医生来说，了解手术过程、结果以及可能出现的并发症，以识别任何潜在问题的体征和症状非常重要。减肥手术的候选人必须体重指数（BMI）至少为40kg/m²，或BMI为35kg/m²且至少有一种合并症，同时证明非手术减肥方法无法控制体重，且无重大精神障碍。手术程序可分为限制性或吸收不良性，包括可调节胃束带、Roux-en-Y胃旁路手术以及带或不带十二指肠转位的胆胰分流术。虽然一般来说，限制性手术可能更适合BMI较低的患者，吸收不良性手术更适合BMI较高的患者，但对于选择任何一种手术并没有明确的标准。减肥手术的效果令人印象深刻，不仅包括显著且持续的体重减轻，还包括主要合并症的改善或缓解。重大并发症包括吻合口漏、边缘溃疡和内疝，以及伤口感染、切口疝、出血、深静脉血栓形成和肺栓塞。目前正在研究的创新手术包括胃肠神经调节、袖状胃切除术、胃内球囊、腔内套管以及其他内镜手术。
