*Section of GI Metabolic Surgery, Department of Surgery †Section of Laparoscopic and Bariatric Surgery, Weill Cornell Medical College New York-Presbyterian Hospital, New York, NY; and ‡Catholic University of Rome, Italy.
Ann Surg. 2014 Jan;259(1):117-22. doi: 10.1097/SLA.0b013e3182759656.
This study investigated the practical clinical consequences of offering surgery for metabolic disease and diabetes as opposed to weight loss.
The terms "metabolic" and "diabetes surgery" indicate a surgical approach whose primary intent is the control of metabolic alterations/hyperglycemia in contrast to "bariatric surgery," conceived as a mere weight-reduction therapy.
A "metabolic surgery" program distinct from the "bariatric surgery" program was recently established at a tertiary US academic medical center. The 2 programs differ in their stated goals but offer the same procedures and use identical eligibility criteria for patients with morbid obesity. Demographics, clinical characteristics, and 30-day postoperative morbidity and mortality were assessed from a prospective database of 200 consecutive patients who underwent surgery at these units.
Metabolic surgery patients were older (45.8±13.4 v 41.8±11.7, P<0.05), had a lower body mass index (42.4±7.1 vs 48.6±9.5 kg/m; P<0.01), and a higher prevalence of being of the male sex (42% vs 26%, P<0.05), having diabetes (62% vs 35%; P<0.01), hypertension (68% vs 52%; P<0.05), dyslipidemia (48% vs 31%; P<0.05), and cardiovascular disease (14% vs 5%; P<0.05). Diabetes was more severe among metabolic surgery patients (higher glycated hemoglobin levels; greater percentage of insulin use). There was no mortality, and there were no differences in perioperative complications.
Offering surgery to treat metabolic disease or diabetes rather than as a mere weight-reduction therapy changes demographical and clinical characteristics of surgical candidates. This has important and practical ramifications for clinical care and support consideration of metabolic/diabetes surgery as a novel practice distinct from traditional bariatric surgery.
本研究旨在探讨代谢病和糖尿病手术（与减重手术相对）与单纯减肥手术相比的实际临床后果。
“代谢”和“糖尿病手术”这两个术语表明，一种手术方法的主要目的是控制代谢改变/高血糖，而“减重手术”则被认为是一种单纯的减肥治疗方法。
最近，一家美国三级学术医疗中心建立了一个与“减重手术”项目不同的“代谢手术”项目。这两个项目在目标上有所不同，但为病态肥胖患者提供相同的手术，并使用相同的资格标准。从这两个单位 200 例连续手术患者的前瞻性数据库中评估了人口统计学、临床特征以及 30 天术后发病率和死亡率。
代谢手术组患者年龄更大（45.8±13.4 岁比 41.8±11.7 岁，P<0.05），体重指数更低（42.4±7.1 千克/平方米比 48.6±9.5 千克/平方米，P<0.01），男性比例更高（42%比 26%，P<0.05），糖尿病患病率更高（62%比 35%，P<0.01），高血压患病率更高（68%比 52%，P<0.05），血脂异常患病率更高（48%比 31%，P<0.05），心血管疾病患病率更高（14%比 5%，P<0.05）。代谢手术组患者的糖尿病更严重（糖化血红蛋白水平更高，胰岛素使用率更高）。无死亡病例，围手术期并发症无差异。
提供治疗代谢病或糖尿病的手术，而不是单纯的减肥治疗，会改变手术候选人的人口统计学和临床特征。这对临床护理具有重要的实际意义，并支持将代谢/糖尿病手术视为一种与传统减重手术不同的新型实践。
