推荐回答（2个）
手术治疗病理性肥胖
肥胖是人体内脂肪的过多积聚，它不仅影响形体美观，给生活带
来诸多不便，也是健康长寿之大敌。据统计，肥胖者并发脑栓塞与心
衰的几率比体重正常者高一倍，患冠心病者比体重正常者多2倍，高
血压发病率比体重正常者多2～6倍，合并糖尿病者较正常人增高4倍，
合并胆石症者较正常人高4～6倍。更为严重的是，肥胖者的寿命明显
缩短，据报道，超重10％的45岁男性，其寿命比正常体重者要缩短4
年。
目前对一般性肥胖的治疗方法可谓五花八门，从控制饮食、增加
运动到内服药物、局部脂肪抽吸、切除等。从自然观念出发，控制饮
食、增加运动可能是最好和最有效的减肥方法。但有一部分伴有心血
管病、代谢性疾病的严重肥胖症者（医学上称为病理性肥胖），各种
常规疗法往往无效，只能通过手术的方法予以减肥。
胃肠外科医师从减少摄食和营养成分吸收的理念出发，尝试进行
减肥治疗，经过近50年的探索，目前已取得了比较可喜的进步。有关
对病理性肥胖的外科治疗始于20世纪50年代。1954年，由Kremen和他
的同事Linner首先介绍了他们提出并施行的一例空回肠旁路手术，方
法是将上部小肠吻合到下部小肠，使大部分的小肠旷置，以影响营养
物质的吸收，达到减肥目的。由于大量的小肠被旷置，病人发生营养
障碍是不可避免的事情，并有众多并发症，如电解质失衡、酸中毒、
贫血、水肿、胆石病、腹胀、难于控制的腹泻、胃肠胀气、继发于钙
及维生素丢失而引起的骨质疏松症、骨软化等，这些严重的并发症影
响了该手术的进一步开展。以后，医生们发现，因胃溃疡接受胃切除
手术治疗的病人，术后倾向于保持低体重状态，在这部分病人中很少
出现体重过度增加，利用这一发现，医生对一些病理性肥胖病人施行
胃部分切除术，术后发现病人体重明显下降。在此基础上医师们又不
断探索，逐步形成了现代的胃成形术或称胃缩容术。这种手术在上世
纪80年代初开始，手术时将胃小弯的垂直部作一个管状胃，并认真地
确定这个管状胃的大小，手术时管状胃的容积大约能容下＜50ml的生
理盐水，在管状胃的出口处用Marlex网包绕，以固定管状胃出口的大
小，防止它以后扩张。手术的后果是限制病人的进食，达到减肥效果。
正确施行这一手术，减肥效果非常明显，由于胃没有旷置部分，并发
症也很少。
欧美国家的肥胖症病人较多，这一手术已被较广泛地应用。近来
腹腔镜手术的开展使得手术创伤大为减轻，因而手术更易被接受。国
内近来也开展了此项工作，但做此手术的适应症是很严格的，并非适
宜所有的肥胖病人。
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