Concors Seth J, Ecker Brett L, Maduka Richard, Furukawa Alyssa, Raper Steven E, Dempsey Daniel D, Williams Noel N, Dumon Kristoffel R
Penn Medicine, Department of Surgery, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Curr Treat Options Neurol. 2016 Jan;18(1):5. doi: 10.1007/s11940-015-0383-0.
Bariatric surgery represents a durable and safe treatment modality for morbid obesity. Bariatric surgery results in weight loss by one of two-and possibly both-primary mechanisms, reducing the amount of tolerable intake (restrictive) and reducing the amount of nutrients absorbed by bypassing absorptive intestine (malabsorptive). These procedures have consistently demonstrated superior resolution of obesity and many associated co-morbid conditions as compared to medical management. Beyond the periprocedural complications of surgery, there are longitudinal risks such as weight regain, anatomic complications, and micronutrient deficiencies. Complications related to the anatomic alteration after bariatric surgery include internal herniation, marginal ulcers, dumping syndrome, and gastric band-related complications. Physicians who take care of bariatric patients at any point in their post-operative care must be vigilant for these complications, as they may necessitate urgent intervention or re-operation. Micronutrient deficiencies, which commonly occur after malabsorptive procedures, may present with a wide range of symptoms-including neuropathies, anemia, poor wound healing, and hair loss, among others. Deficiencies of vitamins and minerals frequently result in the need for long-term supplementation and may necessitate intravenous repletion when severe. Bariatric surgery may also alter the absorption of commonly prescribed medications, including anti-psychotic medications.
减肥手术是治疗病态肥胖的一种持久且安全的治疗方式。减肥手术通过两种主要机制之一（也可能是两种机制同时起作用）实现体重减轻，即减少可耐受摄入量（限制性）和通过绕过吸收性肠道减少营养物质吸收量（吸收不良性）。与药物治疗相比，这些手术在解决肥胖问题及许多相关合并症方面一直表现出更优的效果。除了手术围手术期并发症外，还存在一些长期风险，如体重反弹、解剖学并发症和微量营养素缺乏。减肥手术后与解剖学改变相关的并发症包括内疝、边缘性溃疡、倾倒综合征和胃束带相关并发症。在减肥患者术后护理的任何阶段负责护理的医生都必须警惕这些并发症，因为它们可能需要紧急干预或再次手术。微量营养素缺乏常见于吸收不良手术后，可能表现为多种症状，包括神经病变、贫血、伤口愈合不良和脱发等。维生素和矿物质缺乏常常导致需要长期补充，严重时可能需要静脉补充。减肥手术还可能改变常用处方药的吸收，包括抗精神病药物。
