University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA.
Am Fam Physician. 2011 Oct 1;84(7):805-14.
Bariatric surgery procedures, including laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass, result in an average weight loss of 50 percent of excess body weight. Remission of diabetes mellitus occurs in approximately 80 percent of patients after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Obesity Surgery Mortality Risk Score can help identify patients with increased mortality risk from bariatric surgery. Complications and adverse effects are lowest with laparoscopic surgery, and vary by procedure and presurgical risk. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with standard nutritional supplementation. Outcomes are also influenced by the experience of the surgeon and surgical facility. Overall, these procedures have a mortality risk of less than 0.5 percent. Although there have been no long-term randomized controlled trials, existing studies show that bariatric surgery has a beneficial effect on mortality. The family physician is well positioned to care for obese patients by discussing surgery as an option for long-term weight loss. Counseling about the procedure options, risks and benefits of surgery, and the potential reduction in comorbid conditions is important. Patient selection, presurgical risk reduction, and postsurgical medical management, with nutrition and exercise support, are valuable roles for the family physician.
减重手术程序，包括腹腔镜可调节胃束带术、腹腔镜袖状胃切除术和 Roux-en-Y 胃旁路术，可平均减轻 50%的超重体重。Roux-en-Y 胃旁路术后，约 80%的糖尿病患者病情缓解。其他肥胖相关合并症大大减少，健康相关生活质量得到改善。肥胖手术死亡率风险评分可帮助识别接受减重手术的患者死亡率风险增加。腹腔镜手术的并发症和不良反应最低，具体取决于手术程序和术前风险。Roux-en-Y 手术有发生吸收不良后遗症的风险增加，通过标准营养补充可将其最小化。手术结果还受到外科医生和手术设施经验的影响。总体而言，这些手术的死亡率风险低于 0.5%。尽管没有长期随机对照试验，但现有研究表明，减重手术对死亡率有有益影响。家庭医生通过讨论手术作为长期减肥的一种选择，为肥胖患者提供护理的能力很强。关于手术方案、手术风险和益处以及合并症减少的咨询很重要。患者选择、术前降低风险和术后医疗管理，包括营养和运动支持，是家庭医生的有价值角色。
