Lee Wei-Jei, Almulaifi Abdullah
Department of Surgery, Min-Sheng General Hospital, National Taiwan University, Taoyuan, Taiwan, China.
J Biomed Res. 2015 Apr;29(2):98-104. doi: 10.7555/JBR.28.20140120. Epub 2014 Dec 1.
Obesity and associated type 2 diabetes mellitus (T2DM) are becoming a serious medical issue worldwide. Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese patients. Increasing data indicates bariatric surgery as metabolic surgery is an effective and novel therapy for not well controlled obese T2DM patients. The review of recent developments in bariatric/metabolic surgery covers 4 major fields. 1) Improvement of safety: recent advances in laparoscopic/metabolic surgery has made this minimal invasive surgery more than ten times safer than a decade ago. The safety profile of laparoscopic/metabolic surgery is compatible with that of laparoscopic cholecystectomy now. 2) New bariatric/metabolic surgery: laparoscopic sleeve gastrectomy (LSG) is becoming the leading bariatric surgery because of its simplicity and efficacy. Other new procedures, such as gastric plication, banded plication, single anastomosis (mini) gastric bypass and Duodeno-jejunal bypass with sleeve gastrectomy have all been accepted as treatment modalities for bariatric/metabolic surgery. 3) Mechanism of bariatric/metabolic surgery: Restriction is the most important mechanism for bariatric surgery. Weight regain after bariatric surgery is usually associated with loss of restriction. Recent studies demonstrated that gut hormone, microbiota and bile acid changes after bariatric surgery may play an important role in durable weight loss as well as in T2DM remission. However, weight loss is still the cornerstone of T2DM remission after metabolic surgery. 4) PATIENT SELECTION: patients who may benefit most from bariatric surgery was found to be patients with insulin resistance. For Asian T2DM patients, the indication of metabolic surgery has been set to those with not well controlled (HbA1c > 7.5%) disease and with their BMI > 27.5 Kg/m(2). A novel diabetes surgical score, ABCD score, is a simple system for predicting the success of surgical therapy for T2DM.
肥胖症及相关的2型糖尿病（T2DM）正成为全球范围内一个严重的医学问题。减重手术已被证明是治疗病态肥胖患者最有效且持久的疗法。越来越多的数据表明，作为代谢手术的减重手术对于未得到良好控制的肥胖T2DM患者而言是一种有效且新颖的疗法。对减重/代谢手术近期进展的综述涵盖4个主要领域。1）安全性的提高：腹腔镜/代谢手术的最新进展已使这种微创手术比十年前安全了十多倍。现在腹腔镜/代谢手术的安全状况与腹腔镜胆囊切除术相当。2）新型减重/代谢手术：腹腔镜袖状胃切除术（LSG）因其简便性和有效性正成为主要的减重手术。其他新手术，如胃折叠术、带状折叠术、单吻合（迷你）胃旁路术以及联合袖状胃切除术的十二指肠空肠旁路术，都已被接受为减重/代谢手术的治疗方式。3）减重/代谢手术的机制：限制是减重手术最重要的机制。减重手术后体重反弹通常与限制作用的丧失有关。近期研究表明，减重手术后肠道激素、微生物群和胆汁酸的变化可能在持久减重以及T2DM缓解中发挥重要作用。然而，减重仍然是代谢手术后T2DM缓解的基石。4）患者选择：发现最可能从减重手术中获益的患者是胰岛素抵抗患者。对于亚洲T2DM患者，代谢手术的适应证已设定为疾病未得到良好控制（糖化血红蛋白>7.5%）且体重指数（BMI）>27.5千克/米²的患者。一种新型糖尿病手术评分系统，即ABCD评分，是一种预测T2DM手术治疗成功率的简单系统。
