国际减重与代谢外科最新动态和评价

Latest developments and evaluations in international bariatric and metabolic surgery

70余年来,减重与代谢外科不断发展,对肥胖症与代谢性疾病的认识不断加深,逐渐进入一个多元化的阶段。美国代谢与减重外科学会(ASMBS)也时隔30年再次更新其减重与代谢手术(MBS)指南,对全球减重与代谢外科影响巨大。经过多年的实践,MBS对青少年儿童、老年人两大特殊群体具备确切的效果,年龄不再作为MBS的限制。基于大量循证医学的新术式逐渐被接受,单吻合口胃旁路术(OAGB)正式获得国际学术组织的认可,成为主要的MBS术式。胃袖状切除术联合单吻合口十二指肠-回肠旁路术(SADI-S)和胃袖状切除术联合双通道术(SG-TB)在糖尿病控制方面展现出良好的效果,为合并血糖控制不佳的肥胖症病人提供了新的选择。内镜胃袖状成形术和胃内球囊技术为轻度肥胖的病人提供了优于药物、生活习惯改变的减重效果,在部分研究中甚至不劣于胃袖状切除术(SG)的减重效果。新型减重药物胰高血糖素样肽-1(GLP-1)受体激动剂出现多年,其相关研究仍备受关注,相较于传统减肥药物具有十分明显的减重效果,但适用人群有限、断药反弹等缺点限制其广泛应用。减重数据库象征着减重与代谢外科的规范化。近年来,基于减重数据库的研究数量可观,越来越多国家和地区开始发展高质量的减重数据库。

Bariatric surgery has been continuously developing for over 70 years,with an increasing understanding of obesity and metabolic diseases.It has gradually entered a diversified stage.The American Society for Metabolic and Bariatric Surgery(ASMBS)has updated its weight loss and metabolic surgery guidelines after 30 years,which will have a significant impact on global weight loss and metabolic surgery.After years of practice,weight loss surgery has proven to be effective for two special groups:adolescents and the elderly,and age is no longer a limitation for weight loss and metabolic surgery.Based on a large amount of evidence-based medicine,new surgical techniques are gradually accepted,and OAGB has officially been recognized by international organizations as a major weight loss surgery technique.The single anastomosis duodenal-ileal bypass with sleeve(SADI-S)and sleeve gastrectomy with transit bipartition(SG-TB)techniques has shown good results in the control of diabetes,providing new options for obese patients with uncontrolled blood sugar.Endoscopic sleeve gastroplasty and intragastric balloon provides better weight loss effects than medications and lifestyle changes for mildly obese patients,and in some studies,the weight loss effect is even comparable to that of SG surgery.New weight loss drugs such as glucagon-like peptide-1(GLP-1)receptor agonists have been around for many years,and related research is still being closely watched.Compared with traditional weight loss drugs,they have a very significant weight loss effect,but their limits applicability and rebound after discontinuation limit their widespread use.Weight loss databases symbolize the standardization of weight loss and metabolic surgery.In recent years,the number of studies based on weight loss databases has been considerable,and more and more regions and countries are beginning to develop high-quality weight loss databases.