Kanadys Wiesław Maciej, Leszczyńska-Gorzelak Bozena, Oleszczuk Jan
Poradnia Ginekologiczno-Połoznicza, Przychodnia Specjalistyczna NZOZ, Specjalistyka Czechów".
Ginekol Pol. 2010 Mar;81(3):215-23.
Bariatric surgery is a safe and most effective method of achieving substantial long-term weight loss. Surgery should be considered in case of all patients with a BMI of more than 40 kg/m2 and for those with a BMI of over 35 kg/m2 with obesity-related co-morbidities, after conventional treatment failure. The most frequently used procedures in surgical treatment of obesity performed mostly laparoscopically are restrictive operations limiting energy intake by reducing gastric capacity (vertical banded gastroplasty adjustable gastric band, sleeve gastrectomy) and restrictive/ malabsorptive surgeries also inducing decreased absorption of nutrients by shortening the functional length of the small intestine (Roux-en-Y gastric bypass). Frequent complications following surgery may include hyperemesis, intragastric band migration, gastric perforation, nutritional deficiencies, anastomotic leak, bleeding, anastomotic stricture, internal hernia, wound infection. It is generally recommended for women after bariatric surgery to wait approximately at least 12 months before becoming pregnant. There exists considerable threat that rapid weight loss (relative starvation phase) may be unhealthy for a mother and a baby. Pregnancy after weight loss surgery is not only safe for the mother and the baby but may also be less risky than pregnancy in morbidly obese patients. Postoperative nutrient supplementation and close supervision before, during, and after pregnancy adjusted to individual requirements of a woman can help to prevent nutrition-related complications such as deficiencies in iron, vitamin A, vitamin B12, vitamin K, folate and calcium, and improve maternal and fetal health.
减肥手术是实现长期显著减重的一种安全且最有效的方法。对于所有体重指数(BMI)超过40kg/m²的患者,以及BMI超过35kg/m²且伴有肥胖相关合并症、经传统治疗无效的患者,均应考虑进行手术。肥胖手术治疗中最常用的方法大多通过腹腔镜进行,包括通过减少胃容量来限制能量摄入的限制性手术(垂直束带胃成形术、可调节胃束带术、袖状胃切除术),以及通过缩短小肠功能长度来减少营养吸收的限制性/吸收不良性手术(Roux-en-Y胃旁路术)。手术后常见的并发症可能包括严重呕吐、胃内束带移位、胃穿孔、营养缺乏、吻合口漏、出血、吻合口狭窄、内疝、伤口感染。一般建议减肥手术后的女性至少等待约12个月再怀孕。快速减重(相对饥饿期)对母亲和婴儿可能存在相当大的健康威胁。减肥手术后怀孕不仅对母亲和婴儿安全,而且可能比病态肥胖患者怀孕的风险更低。术后根据女性的个体需求进行营养补充,并在怀孕前、期间和之后进行密切监测,有助于预防与营养相关的并发症,如铁、维生素A、维生素B₁₂、维生素K、叶酸和钙的缺乏,并改善母婴健康。
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