Bariatric surgery for obesity and metabolic conditions in adults.
Bariatric surgery for obesity and metabolic conditions in adults.
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DOI：
10.1136/bmj.g3961
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发表时间：
2014-08-27
期刊：
影响因子：
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通讯作者：
Courcoulas AP
中科院分区：
文献类型：
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作者：
Arterburn DE;Courcoulas AP
本文综述了最近有关减肥手术的安全性、有效性和代谢结果的证据，以指导临床决策。一些短期随机对照试验已经证明了减肥手术在诱导体重减轻和2型糖尿病初步缓解方面的有效性。观察性研究将减肥手术与体重、2型糖尿病、生存率、心血管事件、癌症发病率和生活质量的长期改善联系起来。患者围手术期死亡率一般较低，但亚组间差异很大。手术后主要并发症的发生率也有很大差异，新出现的数据显示，一些手术与药物滥用障碍、自杀和营养缺乏的风险更高有关。需要更多的研究来比较各种手术和亚人群的长期结果，并确定那些最有可能从手术干预中受益的人。考虑到长期减肥手术的风险和收益之间的不确定性，接受手术的决定应该基于高质量的共同决策过程。
This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process.