Pories W J, MacDonald K G
Department of Surgery, East Carolina University School of Medicine, Greenville, NC 27834, USA.
Curr Opin Gen Surg. 1993:195-205.
Several new developments promise to improve the lot of the morbidly obese. Perhaps the most important of these is the gradual recognition that morbid obesity is a serious illness that is not the result of immorality or gluttony but is, in most cases, a disabling genetically determined handicap. The second advance was the agreement at the National Institutes of Health Consensus Conference, March 25-27, 1991 that medical therapies generally fail to control severe obesity and that surgery should be considered for those individuals who have a body mass index over 40 and, if the comorbidities of obesity, such as diabetes or sleep apnea, are present, to consider surgical intervention when the body mass index is greater than 35. The third development has been the improvement of bariatric surgery, ie, the surgery for morbid obesity, with better operations, better quality controls, and rigorous follow-up. This article reviews the newer concepts of morbid obesity as a disease, delineates the indications for surgery, describes the currently recommended operations, and presents the risks and benefits of these procedures.
有几项新进展有望改善病态肥胖者的状况。其中或许最重要的是逐渐认识到，病态肥胖是一种严重疾病，并非不道德或暴饮暴食所致，在大多数情况下，它是一种由基因决定的致残性缺陷。第二个进展是1991年3月25日至27日美国国立卫生研究院共识会议达成的共识，即医学疗法通常无法控制重度肥胖，对于体重指数超过40的个体应考虑手术治疗；如果存在肥胖的合并症，如糖尿病或睡眠呼吸暂停，当体重指数大于35时就应考虑手术干预。第三个进展是减肥手术（即针对病态肥胖的手术）得到了改进，手术方式更好、质量控制更佳且有严格的随访。本文回顾了将病态肥胖视为一种疾病的新观念，阐述了手术指征，描述了目前推荐的手术方式，并介绍了这些手术的风险和益处。
