Rühle Annika, Billeter Adrian T, Müller-Stich Beat P
Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Visc Med. 2022 Feb;38(1):56-62. doi: 10.1159/000521707. Epub 2022 Jan 20.
Obesity and metabolic disorders as type 2 diabetes (T2D), nonalcoholic fatty liver disease (NAFLD) or better called metabolic dysfunction fatty liver disease (MAFLD), arterial hypertension (AHT), and obstructive sleep apnea syndrome (OSAS) show a rising prevalence. The increased cardiovascular risk is one of the main causes for death of obese, metabolic ill patients. Sustainable and efficient therapeutic options are needed.
Metabolic surgery not only permits a substantial and lasting weight loss but also ameliorates metabolic co-morbidities and reduces cardiovascular risk and mortality of obese patients. Most existing data focused on T2D, but evidence for other metabolic co-morbidities such as NAFLD, AHT, and OSAS increase constantly. After metabolic surgery, glycemic control of diabetic patients is superior compared to conservative treatment. Also, diabetes related micro- and macrovascular complications are reduced after surgery, and the median life expectancy is over 9 years longer. In patients with MAFLD, metabolic surgery leads to reduction of steatosis and fibrosis while the risk to develop a hepatocellular carcinoma is reduced significantly. Patients with OSAS have an improved lung function and continuous pressure airway treatment during the night is unnecessary in many patients. Patients with AHT need significantly less or even no antihypertensive medication after surgery and the hazard ratio of death is reduced by 49.2%. Therefore, the focus in treating obese and metabolic ill patients is no longer on pure weight loss but on improvement of co-morbidities and reduction of mortality. This is reflected by the updated S3-guidelines of 2018 that provide nationally established consistent guidelines with clear indications for metabolic surgery no longer focusing on body mass index (BMI) only. This article aims to give an overview over the existing literature concerning surgical treatment options for metabolic syndrome.
Metabolic co-morbidities impact life-quality and life expectancy of obese patients. Metabolic surgery offers the chance to treat those metabolic co-morbidities independently of the preoperative BMI and should be considered early as a treatment option for obese patients.
肥胖及代谢紊乱，如2型糖尿病（T2D）、非酒精性脂肪性肝病（NAFLD）或更确切地称为代谢功能障碍性脂肪性肝病（MAFLD）、动脉高血压（AHT）和阻塞性睡眠呼吸暂停综合征（OSAS）的患病率呈上升趋势。心血管风险增加是肥胖代谢疾病患者死亡的主要原因之一。因此需要可持续且有效的治疗选择。
代谢手术不仅能实现显著且持久的体重减轻，还能改善代谢合并症，降低肥胖患者的心血管风险和死亡率。现有的大多数数据集中在T2D，但关于其他代谢合并症如NAFLD、AHT和OSAS的证据也在不断增加。代谢手术后，糖尿病患者的血糖控制优于保守治疗。此外，术后糖尿病相关的微血管和大血管并发症减少，中位预期寿命延长超过9年。对于MAFLD患者，代谢手术可减轻脂肪变性和纤维化，同时显著降低发生肝细胞癌的风险。OSAS患者的肺功能得到改善，许多患者术后无需夜间持续气道正压通气治疗。AHT患者术后所需的降压药物显著减少甚至无需用药，死亡风险比降低49.2%。因此，治疗肥胖和代谢疾病患者的重点不再仅仅是单纯减重，而是改善合并症和降低死亡率。这在2018年更新的S3指南中得到体现，该指南提供了国家层面一致的指南，明确了代谢手术的适应症，不再仅关注体重指数（BMI）。本文旨在概述有关代谢综合征手术治疗选择的现有文献。
代谢合并症会影响肥胖患者的生活质量和预期寿命。代谢手术为独立于术前BMI治疗这些代谢合并症提供了机会，应尽早将其视为肥胖患者的一种治疗选择。
