Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
Maturitas. 2010 Jul;66(3):223-30. doi: 10.1016/j.maturitas.2010.02.011. Epub 2010 Mar 21.
Advances in the molecular biology of ageing, insulin resistance, inflammation, carcinogenesis and caloric restriction have elucidated commonalities relevant to the chronic overnutrition syndrome termed obesity. Not until the expanded acceptance and availability of surgical treatment of obesity ("bariatric surgery") has it been possible to explore the beneficial effects of sustained voluntary weight loss through controlled undernutrition in freely living people. Bariatric surgery is 58 years old and has undergone dramatic improvements recently becoming significantly safer and more accessible owing to the development of minimally invasive approaches and other advances. Furthermore, it is cost-effective compared to all forms of non-operative treatment. Thus older candidates, with more numerous and severe comorbidities are being recruited, increasing the pool of patients who have had operations which extend the otherwise shorter lives of the obese. Here we describe two mechanistically different operations, gastric restrictive and diversionary, and address their risks, complications, side-effects and beneficial outcomes, in aggregate increasing longevity, reducing morbidity and most important: improving health-related quality-adjusted life years.
衰老、胰岛素抵抗、炎症、癌变和热量限制的分子生物学进展阐明了与慢性营养过剩综合征（称为肥胖）相关的共同特征。直到肥胖的手术治疗（“减肥手术”）得到广泛接受和应用，才有可能通过控制自由生活人群的自愿减重来探索持续减重的有益效果。减肥手术已有 58 年的历史，最近由于微创方法和其他进展的发展，手术变得更加安全和便捷。此外，与所有非手术治疗形式相比，减肥手术具有成本效益。因此，越来越多的年龄较大、合并症更多、更严重的患者被招募，增加了接受手术的患者数量，从而延长了肥胖患者本已较短的寿命。在这里，我们描述了两种机制不同的手术，胃限制术和旁路术，并讨论了它们的风险、并发症、副作用和有益结果，总体上延长了寿命，降低了发病率，最重要的是：提高了与健康相关的调整生命年质量。
