Department of Visceral Surgery, St. Claraspital Basel, CH-4058 Basel, Switzerland.
Langenbecks Arch Surg. 2011 Oct;396(7):949-72. doi: 10.1007/s00423-011-0834-3. Epub 2011 Aug 26.
In the almost six decades of bariatric surgery, a variety of surgical approaches to treating morbid obesity have been developed.
Rather than prior techniques being continually superseded by new ones, a broad choice of surgical solutions based on restrictive, malabsorptive, humoral effects, or combinations thereof, is now available. In fact, in recent years, the advent of surgically modifying human metabolism promises new approaches to ameliorate traditionally medically treated metabolic entities, i.e., diabetes, even in the non-obese. The understanding of the various metabolic effects have led to a paradigm shift from bariatric surgery as a solely weight-reducing procedure to metabolic surgery affecting whole body metabolism.
The bariatric surgeon now faces the challenge and opportunity of selecting the most suitable technique for each individual case. To assist in such decision-making, this review, Metabolic surgery-principles and current concepts, is presented, tracing the historical development; describing the various surgical techniques; elucidating the mechanisms by which glycemic control can be achieved that involve favorable changes in insulin secretion and insulin sensitivity, gut hormones, adipokines, energy expenditure, appetite, and preference for low glycemic index foods; as well as exploring the fascinating future potential of this new interdisciplinary field.
在近六十年的减重手术中,已经开发出了多种治疗病态肥胖的手术方法。
现在有多种基于限制、吸收不良、体液作用或其组合的手术解决方案可供选择,而不是以前的技术被新的技术不断取代。事实上,近年来,通过手术改变人类新陈代谢有望为改善传统上用药物治疗的代谢实体提供新方法,即糖尿病,甚至在非肥胖人群中也是如此。对各种代谢作用的理解导致了从减重手术作为单一的减肥手术到影响全身代谢的代谢手术的范式转变。
现在,减重外科医生面临着为每个个体病例选择最合适技术的挑战和机遇。为了帮助做出这样的决策,本文回顾了代谢手术的历史发展,描述了各种手术技术,阐明了控制血糖的机制,包括胰岛素分泌和胰岛素敏感性、肠道激素、脂肪因子、能量消耗、食欲和对低血糖指数食物的偏好的有利变化,以及探索这个新的跨学科领域令人着迷的未来潜力。