4　手术的现况与选择

理想的减重手术应包括以下几点[ 35 ] : ①危险性低:死亡率< 1% ,并发症率< 10%。②远期结果应至少使75%的病人减去多余体重的50%以上。③副作用少,术后生活质量好。④再手术率低,应每年小于2%。⑤手术可逆。目前最常用的减重手术为腹腔镜胃绕道术和腹腔镜可调节胃束带术。前者是美国减重手术的金标准,是目前最有效的减重手术,但此术式较复杂,有一定死亡率。后者是欧洲和澳洲的标准减重手术,已取代胃隔间术成为全世界最常用的减重手术,且是目前最安全的减重手术,几乎没有死亡率,但是效果较慢,需3年才能逐渐达到最大的效果。近年来由于腹腔镜技术的发展,腹腔镜限制型手术已是减重手术的首选,每年的手术急剧增加。目前全球每年施行减重手术约20万例,其中一半以上在美国完成,是美国最常见的胃肠道手术。

5　减重手术与美容手术的比较

需要强调的是,肥胖是疾病,治疗肥胖是治疗疾病。在西方,减重手术是可以用医疗保险支付的。减重手术不能等同于一般的美容手术,成功减重后全身各处的脂肪组织,包括腹腔内的脂肪均显著减少,血脂降低,各种伴随疾病如糖尿病、高血压、心脑血管疾病等均明显缓解甚至治愈。而美容手术,如抽脂术,虽可抽取高达10 kg的脂肪,但不会改善肥胖引起的各种健康危险因素,因此抽脂术绝不能作为减重手术,仅可作为局部瘦身的美容手术[ 36 ] 。

6　减重治疗应由专业团队完成

现在减重治疗应由包括营养师、理疗师、内科医师、外科医师和精神科医师的一个团队完成,减重手术还要有麻醉师参与。外科医师需经过严格培训、资格认证,还要在有丰富经验的医师帮助下完成一定例数后,方可单独进行这类手术,这是减少并发症和死亡率的关键之一。最近报告显示手术风险与医院每年完成的手术量有关,每年小于50例的医院死亡率为每年大于100 例医院的4倍[ 37 ] ,因此减重手术最好由有专业团队的医院、有经验的医师完成。

7　减重手术在我国的开展前景

减重手术在欧美、澳洲已是常见手术,在我国却开展得很少,并且我国尚无专业的减重外科医师。而我国目前有300万重度肥胖患者,是减重外科的对象,但他们却没有得到适当的治疗。从这两个角度看,减重外科在我国有很好的发展前景。

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