Song Angela, Fernstrom Madelyn H
Division of Plastic Surgery, Department of Surgery, and Fellow of the UPMC Weight Management Center at the University of Pittsburgh School of Medicine, Pittsburg, PA, USA.
Aesthet Surg J. 2008 Mar-Apr;28(2):195-9. doi: 10.1016/j.asj.2008.01.005.
The anatomic and physiological changes resulting from bariatric surgery can affect both nutrition and psychological attitudes. Modifications of the gastrointestinal tract lead to a diminished ability to absorb nutrients, electrolytes, and bile salts, as well as deficiencies in iron, calcium, and other vitamins and minerals. Dehydration, lactose intolerance, and protein calorie malnutrition are other common sequelae. Alterations in bone metabolism increase long-term risk for osteopenia and osteoporosis. Noncompliance with postsurgical nutritional regimens has been estimated to occur in from one third to almost two thirds of cases and can exacerbate these complications. Psychological issues are often present in patients with morbid obesity and can affect surgical outcomes. These issues include mood and personality disorders, destructive eating behaviors, and poor body image. Nearly one third of patients undergoing bariatric surgery also have a history of substance abuse disorder. The literature suggests that although the mental health of patients improves as a result of bariatric surgery, the benefits may be transient, and problems such as negative personality profiles, detrimental eating patterns, and negative body image persist to some extent. Identification of presurgical psychiatric problems can help identify those patients more likely to achieve lasting weight loss when surgery is combined with long-term follow-up to minimize medical and psychological complications.
减肥手术引起的解剖学和生理学变化会影响营养状况和心理态度。胃肠道的改变导致吸收营养物质、电解质和胆盐的能力下降，以及铁、钙和其他维生素及矿物质的缺乏。脱水、乳糖不耐受和蛋白质热量营养不良是其他常见的后遗症。骨代谢的改变增加了骨质疏松症和骨质疏松的长期风险。据估计，三分之一到几乎三分之二的病例会出现术后营养方案依从性差的情况，这会加剧这些并发症。心理问题在病态肥胖患者中经常出现，并且会影响手术结果。这些问题包括情绪和人格障碍、破坏性饮食行为以及不良的身体形象。近三分之一接受减肥手术的患者也有药物滥用障碍史。文献表明，尽管减肥手术会改善患者的心理健康，但这种益处可能是短暂的，负面人格特征、有害饮食模式和负面身体形象等问题在一定程度上仍然存在。术前识别精神问题有助于确定那些在手术结合长期随访以尽量减少医学和心理并发症时更有可能实现持久体重减轻的患者。
