成人肥胖症

可能由于吃太多或者吃太快引起， 短期并发症也包括组织水肿。

减重手术后饮食指导很重要，可以避免过量进食。 如果恶心和呕吐不是由其他原因引起，则患者可以放心。[241]McMahon MM, Sarr MG, Clark MM, et al. Clinical management after bariatric surgery: value of a multidisciplinary approach. Mayo Clin Proc. 2006 Oct;81(10 suppl):S34-45.http://www.ncbi.nlm.nih.gov/pubmed/17036577?tool=bestpractice.com

Bariatric surgery sequelae

肺不张和肺炎是最常见的肺部并发症。 因为伤口疼痛，患者常常只敢呼吸得较浅。 通过适当的镇痛、早期活动、使用诱导性肺量器和深呼吸/咳嗽训练，可减少肺不张的频率。[242]Frantzides CT, Carlson MA, Schulte WJ. Laparoscopic gastric bypass in a porcine model. J Laparoendosc Surg. 1995 Apr;5(2):97-100.http://www.ncbi.nlm.nih.gov/pubmed/7612950?tool=bestpractice.com

Hospital-acquired pneumonia

因制动、脱水和高凝状态导致。[243]Agarwal R, Hecht TE, Lazo MC, et al. Venous thromboembolism prophylaxis for patients undergoing bariatric surgery: a systematic review. Surg Obes Relat Dis. 2010 Mar 4;6(2):213-20.http://www.ncbi.nlm.nih.gov/pubmed/20176509?tool=bestpractice.com[244]Frantzides CT, Welle SN, Ruff TM, et al. Routine anticoagulation for venous thromboembolism prevention following laparoscopic gastric bypass. JSLS. 2012 Jan-Mar;16(1):33-7.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407454/http://www.ncbi.nlm.nih.gov/pubmed/22906327?tool=bestpractice.com

Deep vein thrombosis

因制动、脱水和高凝状态导致。[244]Frantzides CT, Welle SN, Ruff TM, et al. Routine anticoagulation for venous thromboembolism prevention following laparoscopic gastric bypass. JSLS. 2012 Jan-Mar;16(1):33-7.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407454/http://www.ncbi.nlm.nih.gov/pubmed/22906327?tool=bestpractice.com[245]Rajasekhar A, Crowther M. Inferior vena caval filter insertion prior to bariatric surgery: a systematic review of the literature. J Thromb Haemost. 2010 Jun;8(6):1266-70.http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2010.03858.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/20345723?tool=bestpractice.com

Pulmonary embolism

多由外科技术失误引起。 如果患者临床情况稳定，出血不再继续，可行非手术管理。 若保守治疗失败，行手术治疗。

Bariatric surgery sequelae

因肠道污染（尤其在胃转流术中常见）或者未严格执行外科无菌技术。 伤口蜂窝组织炎可以采用抗生素治疗，但如果出现脓性引流物，则须进行再次手术。 如果和异体相关（放置胃束带），可能需要移除胃束带。

Bariatric surgery sequelae

常发生于胃转流术中切开迷走神经后。 倾倒综合征患者应避免摄入浓缩糖。[246]Frantzides CT, Carlson MA, Shostrom VK, et al. A survey of dumping symptomatology after gastric bypass with or without lesser omental transection. Obes Surg. 2011 Feb;21(2):186-93.http://www.ncbi.nlm.nih.gov/pubmed/20379798?tool=bestpractice.com

Bariatric surgery sequelae

原因是组织缺血或吻合技术失误。 早期诊断和手术干预是重要的，可以减少该并发症的发病率。

Bariatric surgery sequelae

最常见是由于术后肺栓塞或者肠漏引起。

腹型或向心性肥胖和冠状动脉疾病存在关联，很多研究者认为腹部肥胖是冠状动脉疾病的独立危险因素。[214]Ritchie SA, Connell JM. The link between abdominal obesity, metabolic syndrome and cardiovascular disease. Nutr Metab Cardiovasc Dis. 2007 May;17(4):319-26.http://www.ncbi.nlm.nih.gov/pubmed/17110092?tool=bestpractice.com[215]Donahue RP, Abbott RD, Bloom E, et al. Central obesity and coronary heart disease in men. Lancet. 1987 Apr 11;1(8537):821-4.http://www.ncbi.nlm.nih.gov/pubmed/2882231?tool=bestpractice.com[216]Rexrode KM, Carey VJ, Hennekens CH, et al. Abdominal adiposity and coronary heart disease in women. JAMA. 1998 Dec 2;280(21):1843-8.http://jama.ama-assn.org/cgi/content/full/280/21/1843http://www.ncbi.nlm.nih.gov/pubmed/9846779?tool=bestpractice.com[217]Manson JE, Colditz GA, Stampfer MJ, et al. A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med. 1990 Mar 29;322(13):882-9.http://www.nejm.org/doi/full/10.1056/NEJM199003293221303#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/2314422?tool=bestpractice.com BMI可能不是冠心病的独立危险因素。[218]Romero-Corral A, Montori VM, Somers VK, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006 Aug 19;368(9536):666-78.http://www.ncbi.nlm.nih.gov/pubmed/16920472?tool=bestpractice.com[219]Wessel TR, Arant CB, Olson MB, et al. Relationship of physical fitness vs body mass index with coronary artery disease and cardiovascular events in women. JAMA. 2004 Sep 8;292(10):1179-87.http://jama.ama-assn.org/cgi/content/full/292/10/1179http://www.ncbi.nlm.nih.gov/pubmed/15353530?tool=bestpractice.com

Overview of acute coronary syndrome

肥胖和 2 型糖尿病存在证据充分的关联，现在已公认肥胖是糖尿病的危险因素。[220]Ogden CL, Yanovski SZ, Carroll MD, et al. The epidemiology of obesity. Gastroenterology. 2007 May;132(6):2087-102.http://www.ncbi.nlm.nih.gov/pubmed/17498505?tool=bestpractice.com[221]Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med. 1993 Oct 1;119(7):655-60.http://www.ncbi.nlm.nih.gov/pubmed/8363192?tool=bestpractice.com[214]Ritchie SA, Connell JM. The link between abdominal obesity, metabolic syndrome and cardiovascular disease. Nutr Metab Cardiovasc Dis. 2007 May;17(4):319-26.http://www.ncbi.nlm.nih.gov/pubmed/17110092?tool=bestpractice.com[222]Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003 Jan 1;289(1):76-9.http://jama.ama-assn.org/cgi/content/full/289/1/76http://www.ncbi.nlm.nih.gov/pubmed/12503980?tool=bestpractice.com[223]Van Itallie TB. Health implications of overweight and obesity in the United States. Ann Intern Med. 1985 Dec;103(6):983-8.http://www.ncbi.nlm.nih.gov/pubmed/4062130?tool=bestpractice.com[224]Wilson JB, Pories WJ. Durable remission of diabetes after bariatric surgery: what is the underlying pathway? Insulin. 2010 Jan;5(1):46-55.

Type 2 diabetes in adults

认为肥胖（尤其是腹部肥胖）是脂质代谢疾病（包括高胆固醇血症）的一个危险因素。[110]Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med. 2002 Oct 14;162(18):2074-9.http://archinte.ama-assn.org/cgi/content/full/162/18/2074http://www.ncbi.nlm.nih.gov/pubmed/12374515?tool=bestpractice.com[214]Ritchie SA, Connell JM. The link between abdominal obesity, metabolic syndrome and cardiovascular disease. Nutr Metab Cardiovasc Dis. 2007 May;17(4):319-26.http://www.ncbi.nlm.nih.gov/pubmed/17110092?tool=bestpractice.com[223]Van Itallie TB. Health implications of overweight and obesity in the United States. Ann Intern Med. 1985 Dec;103(6):983-8.http://www.ncbi.nlm.nih.gov/pubmed/4062130?tool=bestpractice.com[225]Fujioka S, Matsuzawa Y, Tokunaga K, et al. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism. 1987 Jan;36(1):54-9.http://www.ncbi.nlm.nih.gov/pubmed/3796297?tool=bestpractice.com[226]Williams DP, Going SB, Lohman TG, et al. Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. Am J Public Health. 1992 Mar;82(3):358-63.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694353/http://www.ncbi.nlm.nih.gov/pubmed/1536350?tool=bestpractice.com[227]Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004 Mar;79(3):379-84.http://www.ajcn.org/cgi/content/full/79/3/379http://www.ncbi.nlm.nih.gov/pubmed/14985210?tool=bestpractice.com

Hypercholesterolaemia

肥胖与高血压相关，似乎也是高血压的一个危险因素。[110]Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med. 2002 Oct 14;162(18):2074-9.http://archinte.ama-assn.org/cgi/content/full/162/18/2074http://www.ncbi.nlm.nih.gov/pubmed/12374515?tool=bestpractice.com[223]Van Itallie TB. Health implications of overweight and obesity in the United States. Ann Intern Med. 1985 Dec;103(6):983-8.http://www.ncbi.nlm.nih.gov/pubmed/4062130?tool=bestpractice.com[226]Williams DP, Going SB, Lohman TG, et al. Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. Am J Public Health. 1992 Mar;82(3):358-63.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694353/http://www.ncbi.nlm.nih.gov/pubmed/1536350?tool=bestpractice.com[227]Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004 Mar;79(3):379-84.http://www.ajcn.org/cgi/content/full/79/3/379http://www.ncbi.nlm.nih.gov/pubmed/14985210?tool=bestpractice.com[228]The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels: results of the trials of hypertension prevention, phase I. JAMA. 1992 Mar 4;267(9):1213-20.http://www.ncbi.nlm.nih.gov/pubmed/1586398?tool=bestpractice.com[229]Rahmouni K, Correia ML, Haynes WG, et al. Obesity-associated hypertension: new insights into mechanisms. Hypertension. 2005 Jan;45(1):9-14.http://hyper.ahajournals.org/cgi/content/full/45/1/9http://www.ncbi.nlm.nih.gov/pubmed/15583075?tool=bestpractice.com

Essential hypertension

肥胖和非酒精性脂肪肝（NAFLD）相关。

NAFLD 有一系列广泛的临床表现，从单纯性脂肪肝到伴有炎症、晚期纤维化和终末期肝病的肝脂肪变性。[230]Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T, et al. Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev. 2010;(1):CD007340.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007340.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/20091629?tool=bestpractice.com

Hepatic steatosis

中心性肥胖是代谢综合征（定义为中心性肥胖/腰围增大、高血压、血脂异常、空腹血糖升高）的危险因素之一。

Metabolic syndrome

肥胖和癌症之间存在证据充分的关联，现在已公认肥胖是某些类型癌症，包括乳腺（绝经后）、子宫内膜、结肠、肾脏和食管癌的危险因素。[231]Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004 Aug;4(8):579-91.http://www.ncbi.nlm.nih.gov/pubmed/15286738?tool=bestpractice.com[232]Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003 Apr 24;348(17):1625-38.http://www.nejm.org/doi/full/10.1056/NEJMoa021423#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/12711737?tool=bestpractice.com[233]Giovannucci E, Michaud D. The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology. 2007 May;132(6):2208-25.http://www.ncbi.nlm.nih.gov/pubmed/17498513?tool=bestpractice.com

大型流行病学研究显示肥胖和全因死亡之间存在关联。[234]Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006 Aug 24;355(8):763-78.http://www.nejm.org/doi/full/10.1056/NEJMoa055643#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/16926275?tool=bestpractice.com[235]Flegal KM, Graubard BI, Williamson DF, et al. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005 Apr 20;293(15):1861-7.http://jama.ama-assn.org/cgi/content/full/293/15/1861http://www.ncbi.nlm.nih.gov/pubmed/15840860?tool=bestpractice.com[236]Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000. JAMA. 2004 Mar 10;291(10):1238-45.http://www.ncbi.nlm.nih.gov/pubmed/15010446?tool=bestpractice.com[237]Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of US adults. N Engl J Med. 1999 Oct 7;341(15):1097-105.http://www.nejm.org/doi/full/10.1056/NEJM199910073411501#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/10511607?tool=bestpractice.com[238]Yu E, Ley SH, Manson JE, et al. Weight history and all-cause and cause-specific mortality in three prospective cohort studies. Ann Intern Med. 2017 May 2;166(9):613-20.http://www.ncbi.nlm.nih.gov/pubmed/28384755?tool=bestpractice.com

在吸收不良型手术中更容易发生。 补充维生素应该包括脂溶性维生素A、D、E、K。

Bariatric surgery sequelae

在术后监测蛋白，直到稳定。

Bariatric surgery sequelae

减重手术对于药物吸收的影响是因药物而异的。 吸收不良可能性大的药物是那些本身就难以吸收的、高度亲脂性药物或者经过肠肝循环的。 可能需要调整个体剂量并进行治疗监测。[239]Padwal R, Brocks D, Sharma AM. A systematic review of drug absorption following bariatric surgery and its theoretical implications. Obes Rev. 2010 Jan;11(1):41-50.http://www.ncbi.nlm.nih.gov/pubmed/19493300?tool=bestpractice.com

肥胖和某些妊娠期并发症相关，例如妊娠糖尿病、先兆子痫、妊娠高血压等。 减重手术治疗的女性可能患有这些并发症的风险减少。 尚无证据证明减重手术和增加的剖宫产率或者分娩并发症率相关。 减肥手术后，生育能力也可能得到改善。[240]Shekelle PG, Newberry S, Maglione M, et al. Bariatric surgery in women of reproductive age: special concerns for pregnancy. Evid Rep Technol Assess (Full Rep). 2008 Nov;(169):1-51.http://www.ncbi.nlm.nih.gov/pubmed/20731480?tool=bestpractice.com

因为肌肉以及前腹壁筋膜切除引起。 使用腹腔镜后发生率减少。 诊断为切口疝后，为防止肠内容物的嵌顿以及肠绞窄的风险，应该行修补术。

Bariatric surgery sequelae

因为肠系膜裂孔疝与胃转流术相关， 诊断为腹内疝后，为防止肠缺血及肠坏死，应该行修补术。

Bariatric surgery sequelae

因为胃周分离技术在放置胃束带过程中进行的过早。 胃束带滑脱在使用松弛部技术时发生率更低。 确诊后，需要进行手术修正。[208]Favretti F, Segato G, Ashton D, et al. Laparoscopic adjustable gastric banding in 1791 consecutive obese patients: 12-year results. Obes Surg. 2007 Feb;17(2):168-75.http://www.ncbi.nlm.nih.gov/pubmed/17476867?tool=bestpractice.com

Bariatric surgery sequelae

短期发生，该并发症是在放置胃束带时肠道损伤引起。 长期发生，可能由于异物植入引起。 一旦诊断，及时手术干预。

Bariatric surgery sequelae