Schroeder Robin, Harrison T Daniel, McGraw Shaniqua L
Leigh Valley Health Network, Allentown, PA, USA.
Am Fam Physician. 2016 Jan 1;93(1):31-7.
In 2013, approximately 179,000 bariatric surgery procedures were performed in the United States, including the laparoscopic sleeve gastrectomy (42.1%), Roux-en-Y gastric bypass (34.2%), and laparoscopic adjustable gastric banding (14.0%). Choice of procedure depends on the medical conditions of the patient, patient preference, and expertise of the surgeon. On average, weight loss of 60% to 70% of excess body weight is achieved in the short term, and up to 50% at 10 years. Remission of type 2 diabetes mellitus occurs in 60% to 80% of patients two years after surgery and persists in about 30% of patients 15 years after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with nutritional supplementation and surveillance. Overall, these procedures have a mortality risk of less than 0.5%. Cohort studies show that bariatric surgery reduces all-cause mortality by 30% to 50% at seven to 15 years postsurgery compared with patients with obesity who did not have surgery. Dietary changes, such as consuming protein first at every meal, and regular physical activity are critical for patient success after bariatric surgery. The family physician is well positioned to counsel patients about bariatric surgical options, the risks and benefits of surgery, and to provide long-term support and medical management postsurgery.
2013年，美国实施了约17.9万例减肥手术，其中包括腹腔镜袖状胃切除术（42.1%）、Roux-en-Y胃旁路术（34.2%）和腹腔镜可调节胃束带术（14.0%）。手术方式的选择取决于患者的医疗状况、患者偏好以及外科医生的专业技能。短期内，平均可减轻60%至70%的超重体重，10年后可达50%。2型糖尿病在术后两年内缓解的患者比例为60%至80%，在Roux-en-Y胃旁路术后15年仍有约30%的患者保持缓解。其他与肥胖相关的合并症也大幅减少，健康相关生活质量得到改善。Roux-en-Y手术出现吸收不良后遗症的风险增加，可通过营养补充和监测将其降至最低。总体而言，这些手术的死亡风险低于0.5%。队列研究表明，与未接受手术的肥胖患者相比，减肥手术在术后7至15年可使全因死亡率降低30%至50%。饮食改变，如每餐先摄入蛋白质，以及定期进行体育活动，对减肥手术后患者的成功至关重要。家庭医生有能力为患者提供有关减肥手术选择、手术风险和益处的咨询，并在术后提供长期支持和医疗管理。
