减重手术后复胖原因与治疗对策

Causes and countermeasures for weight regain after bariatric surgery

  • 摘要: 减重手术是治疗肥胖症及其相关代谢疾病的有效方式,但病人术后复胖是常见和不容忽视的问题。术后复胖的原因复杂,需多学科团队全面评估和长期稳定随访。术后复胖病人的治疗方案应根据其解剖学情况、生活习惯、心理状态和依从性等方面给予个性化指导。笔者分析目前针对术后复胖影响因素的回顾性和前瞻性研究,总结关于术后复胖行为、药物和手术治疗效果的临床证据,提出需建立减重手术后复胖的统一诊断标准。通过前瞻性研究明确减重手术后病人复胖的预测因子、建立手术和非手术干预方式的最佳组合、探寻药物治疗的最佳时间节点,对于有效维持减重手术效果、防治术后复胖具有重要意义。

     

    Abstract: Although bariatric surgery is the most effective and durable treatment for obesity and related metabolic diseases, weight regain (WR) after surgery is a common problem and cannot be neglected. The causes of WR are complex and require a comprehensive assessment and long‑term follow‑up conducted by a multidisciplinary team. The treatment for WR should be indivi-dualized according to the anatomical condition, lifestyle habits, psychological state, and compliance of patients. The authors review the current retrospective and prospective studies on the risk factors for WR, and summarize the clinical evidence on the behavioral, pharmacotherapeutic, and surgical interventions. Basing on the available research results, the authors consider that harmonized criteria for WR diagnosis is imperative. It is necessary to further clarify WR predictors, optimal combination of surgical and non‑surgical therapies, and to explore the ideal time‑point of medication usage by designing prospective studies, which have great importance for maintaining weight loss and preven-tion and treatment of WR after bariatric surgery.

     

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