手术治疗肥胖症及糖尿病——在共识与争议中发展

Surgical treatment for obesity and type 2 diabetes mellitus:development with consensus and controversy

肥胖症已经成为现今社会所面临的最严重的公共健康问题之一,手术治疗是使肥胖症病人获得长期而稳定的减重效果的唯一手段。自从20世纪50年代出现第一例减肥手术的报道以来,胃肠外科手术治疗肥胖症在全球范围内获得了很大的发展,已经成为治疗病态肥胖的"金标准"。在2000年开展国内第一例腹腔镜下垂直绑带式胃减容术之后,笔者单位还开展了腹腔镜下可调节胃绑带术、"Y"型胃肠短路术、改良简易型胃肠短路术、管状胃胃切除术等,并且所有手术均在腹腔镜的条件下完成,取得了非常好的效果。随着研究的不断深入,越来越多的证据表明,胃肠外科手术不仅能减重,同时可能改善甚至治愈肥胖症相关的多种代谢性疾病,尤其是2型糖尿病。目前国内外的胃肠外科医师们正致力于将手术推广到2型糖尿病的治疗中去。外科手术治疗代谢性疾病仍有巨大的发展空间。

Obesity has already been one of the most serious society-facing problems. Surgical treatment is the only way to cause stable and steady weight loss. Since reported in the 1950s for the first time, gastrointestinal surgery has greatly developed as the golden standard in obesity treatment. In 2000, Changhai Hospital took the first laparoscopic vertical banded gastroplasty in China. During the next 10 years, they also did laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, mini gastric bypass, sleeve gastrectomy, etc. All of these operations were done with laparoscopy with good treatment effect. With the convincing research and evidence, it is found that gastrointestinal surgery not only can cause weight loss, but can relieve, even cure many metabolic diseases associated with obesity, and especially type 2 diabetes mellitus. Currently, gastrointestinal surgeons are focusing on the operation treatment for type 2 diabetes mellitus. Surgical treatment for metabolic diseases has a huge potential for development.