Mancini Marcio C
Endocrinology & Metabolism Department, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Arq Bras Endocrinol Metabol. 2014 Dec;58(9):875-88. doi: 10.1590/0004-2730000003413.
Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdisciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgical candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic treatments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia.
肥胖是一个主要的公共卫生问题，与死亡率风险增加、多种合并症的发生相关，并缩短预期寿命。减重手术是治疗病态肥胖患者最有效的方法，可降低发生新合并症、医疗保健利用和死亡率的风险。随着时间的推移，建立拥有跨学科工作人员的减重手术卓越中心一直在降低手术死亡率，提高手术安全性和质量。内分泌科医生是跨学科团队的一部分。本综述的目的是为内分泌科医生、内科医生和医疗保健提供者提供在管理病态肥胖的减重手术候选者时良好临床实践的关键要素。这些信息包括减重手术的正式适应证和禁忌证、常见减重和代谢手术以及内镜治疗的描述、术前评估，包括心理、代谢和心肺评估，以及术后饮食分阶段进餐进展和营养补充随访，同时监测微量营养素缺乏情况、手术并发症、2型糖尿病患者药物的停用、倾倒综合征和低血糖。
