中国减重代谢外科发展及对手术并发症的思考

The development of bariatric and metabolic surgery in China and the consideration of sur-gical complications

纵观全世界减重代谢外科经典手术方式和新手术方式的布局与比例,胃袖状切除术以其日渐凸显的优势正成为最被接受和推崇的减重手术方式,其手术量甚至已超过“金标准”手术方式Roux-en-Y胃旁路术。在我国,这种趋势尤为明显。随着部分缺乏胃肠外科临床经验的医师以及更多年轻医师进入减重代谢外科,临床实践中相继出现操作相关手术并发症和围手术期管理经验不足问题,包括消化道漏、出血、管腔及吻合口狭窄、内疝与梗阻、静脉血栓栓塞等。减重代谢外科是胃肠外科的分支,其专科医师应具备对术后近、远期并发症的预防、预判和处理能力。笔者认为:通过对实验室指标、患者体征及相关检查的综合评估,果断选择时机、正确决策并采取有力措施是减重代谢外科医师的基本素养。

Analysis of the layout and proportion of classic and innovative surgical procedures of bariatric and metabolic surgery throughout the world,the sleeve gastrectomy is beco-ming the most accepted and respected surgical procedure with its increasingly prominent advan-tages,and its operation number has even exceeded the"gold standard"surgery of the roux-en-Y gastric bypass.This trend is even more pronounced in China.With a small number of physicians lacking experience in gastrointestinal surgery and more and more young physicians joining in the field of bariatric and metabolic surgery,operation related complications and the consequences of insufficient perioperative management experience have occurred successively in clinical practice,such as gastrointestinal leakage,bleeding,lumen and anastomotic stenosis,internal hernia and obstruction,venous thromboembolism,etc.Bariatric and metabolic surgery is a branch of gastro-intestinal surgery,and physicians in the field should have the ability to prevent,predict and manage short-and long-term complications after surgery.The authors believe that through the comprehen-sive evaluation of laboratory indexes,patient signs and related examinations,physicians should have the basic qualities of decisively choosing the surgical timing,choosing the right decision-making,and taking effective measures.