Brolin R E
Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick.
Gastroenterol Clin North Am. 1987 Jun;16(2):317-38.
Assessment of the outcome of obesity operations is exceedingly complex. Currently there is no consensus among bariatric surgeons as to what constitutes successful weight loss. Furthermore, weight loss data must be regularly reevaluated to account for later regaining of lost weight. There is no question that surgically-induced weight loss results in improvement or resolution of obesity-related medical problems in most patients. Yet it is not known whether sustained long-term weight loss will result in extended amelioration of these medical problems. Analysis of outcome is further complicated by difficulties in maintaining consistent long-term follow-up in such a way that the benefits of weight loss can be objectively evaluated. The next decade should provide improvements in a number of these problem areas. The new computer registry of the American Society of Bariatric Surgery has access to thousands of bariatric surgical patients. This registry will hopefully provide for some standardization in analysis and reporting of results of bariatric operations. The registry may eventually be able to provide the type of actuarial analysis of long-term results necessary to assess the true impact of bariatric operations on the morbidity and mortality risks associated with morbid obesity. It is also probable that more sophisticated patient selection methods will improve the likelihood of successful weight loss both by excluding patients who are prone to failure and by identification of patient profiles that are better suited for treatment by one type of operation over another. In the final analysis, there is no question that morbid obesity poses an increased risk to health and longevity. Thus it is only logical that substantial weight loss in this group of patients could be expected to improve both longevity and quality of life, provided that the treatment methods employed are free of serious side-effects. At present, surgery offers the only realistic hope for successful weight loss in the morbidly obese.
评估肥胖症手术的结果极其复杂。目前，减肥外科医生对于什么构成成功的体重减轻尚未达成共识。此外，必须定期重新评估体重减轻数据，以考虑后期体重的反弹。毫无疑问，手术导致的体重减轻会使大多数患者的肥胖相关医疗问题得到改善或解决。然而，尚不清楚长期持续的体重减轻是否会使这些医疗问题得到进一步改善。由于难以以能够客观评估体重减轻益处的方式保持一致的长期随访，结果分析变得更加复杂。未来十年应该会在许多这些问题领域有所改进。美国减肥外科学会的新计算机登记系统可以获取数千名减肥手术患者的信息。这个登记系统有望为减肥手术结果的分析和报告提供一些标准化。该登记系统最终可能能够提供必要的长期结果精算分析类型，以评估减肥手术对与病态肥胖相关的发病和死亡风险的真正影响。也有可能更复杂的患者选择方法将提高成功减肥的可能性，这既可以通过排除容易失败的患者，也可以通过识别更适合某种手术治疗的患者特征来实现。归根结底，毫无疑问，病态肥胖会增加健康和长寿的风险。因此，合乎逻辑的是，只要所采用的治疗方法没有严重的副作用，这组患者的大量体重减轻有望提高寿命和生活质量。目前，手术是病态肥胖患者成功减肥的唯一现实希望。
