减重手术对肥胖相关代谢异常的作用

Effects of bariatric surgery on obesity-related metabolic diseases

减重代谢手术减轻体重、改善代谢的长期效果已得到全球专家的广泛认可。临床已观察到减重代谢手术对肥胖相关2型糖尿病、高血压病、多囊卵巢综合征、代谢相关脂肪性肝病、远期心脑血管病等代谢紊乱的显著疗效。但现行指南推荐手术治疗2型糖尿病的BMI切点相对保守;且新的代谢手术方式如单吻合口十二指肠回肠吻合术,也展现出现极佳的减重降糖的临床效果,何种术式最适合肥胖合并2型糖尿病等代谢疾病患者仍无定论,需要更多包含中国人群的高质量临床证据加以验证并付诸临床。文章根据同济大学附属上海第十人民医院内分泌代谢中心基础及临床研究结果和文献综述,对上述减重代谢手术治肥胖相关代谢疾病的若干问题做一探讨。

Bariatric surgery has been widely recognized by experts around the world for its long-term effect on weight loss and metabolic function.Prolonged remission of type 2 diabetes mellitus,polycystic ovary syndrome,hypertension,metabolic associated fatty liver disease and other metabolic disorders have been observed in several prospective clinical studies.However,the recommended BMI cut-off point for surgery in current Chinese guidelines is relatively conservative,falling short of the need of clinical practice.In addition,innovative surgical procedures,like single anastomosis duodenoileal bypass with sleeve gastrectomy,has demonstrated equivalent therapeutic effect to classic technique such as biliopancreatic diversion with duodenal switch,leaving the unclarity of which surgical modality may yield the best result for petients with diabetes or other obesity related comorbidity.High-quality clinical evidences are urgently needed to guide the usage of these rising surgical procedures in Chinese population.In summary,we conducted a thorough review on previous literatures and gave pertinent comments aiming to disclose these hot issues in bariatric field.