California Medical Innovations Institute, San Diego, California, USA.
Swedish Weight Loss Services, Seattle, Washington, USA.
Obesity (Silver Spring). 2019 Nov;27(11):1776-1783. doi: 10.1002/oby.22623. Epub 2019 Sep 23.
Obesity has reached global epidemic proportions in recent decades. Bariatric surgery is currently accepted as most effective in alleviating morbid obesity and related disorders. Sleeve gastrectomy (SG) and adjustable gastric banding (AGB) have gained popularity since the beginning of this century because of their efficacy, safety, and simplicity. SG, in particular, has emerged as the most popular bariatric procedure because of its simpler concept and shorter operative time compared with gastric bypass. Caloric restriction, however, cannot account for the sustained weight loss and improved glucose metabolism seen following SG and AGB. Other mechanisms, including changes in gastrointestinal hormone secretion, rearrangement of hypothalamic and vagal control, alteration in energy expenditure, and re-regulation of bile acid metabolism and the intestinal flora environment, are thought to contribute to the postoperative benefits. This review focuses on clinical and experimental literature addressing the potential mechanisms for SG and AGB procedures in human and animal models. Understanding such mechanisms can provide important insight into how current gastric restrictive procedures work and how future treatments of obesity, both surgical and nonsurgical, can be developed.
肥胖症在近几十年已达到全球流行的程度。减重手术目前被认为是缓解病态肥胖及其相关疾病最有效的方法。自本世纪初以来，胃袖状切除术（SG）和可调胃束带术（AGB）因其疗效、安全性和简单性而受到欢迎。与胃旁路术相比，SG 具有更简单的概念和更短的手术时间，因此已成为最受欢迎的减重手术。然而，热量限制并不能解释 SG 和 AGB 术后持续的体重减轻和改善的葡萄糖代谢。其他机制，包括胃肠道激素分泌的变化、下丘脑和迷走神经控制的重新排列、能量消耗的改变以及胆汁酸代谢和肠道菌群环境的重新调节，被认为有助于术后获益。本文综述了关于 SG 和 AGB 手术在人体和动物模型中的潜在机制的临床和实验文献。了解这些机制可以为当前胃限制性手术的作用机制以及肥胖症的未来治疗方法（包括手术和非手术方法）提供重要的见解。
