비만수술
Bariatric Surgery
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초록
고도비만의 치료에서 현재로서는 비만수술만이 유일한 해결책이라는 견해에는 이견이 없다. 60년의 역사 속에 이제는 비만수술의 유용성을 뒷받침할 충분한 의학적 근거를 갖추었다. 현재 위밴드술, 위우회술, 위소매 절제술, 그리고 담췌십이지장 전환술이 가장 널리 시행되고 있는데 어느 수술 방법도 완벽하게 어느 다른 수술보다 월등히 우월하다고 단정할 수 없음을 반영할 수도 있다. 향후 고도비만 환자의 특성에 맞는 환자의 욕구를 충족시켜줄 수 있는 적절한 수술 방법의 연구 개발은 계속될 것이다. 미국의 경우 2008년 약 22,000예의 비만수술이 행하여 진 것으로 보고되고 있으며 이는 미국의 어떤 암수술보다 훨씬 많은 예이다. 그러나 이들은 아직 비만수술의 필요성에 대한 홍보와 여러 사회적인 여건의 조성이 미흡하여 실제 비만수술의 적응이 되는 고도비만 환자의 2% 미만이 수술의 혜택을 받을 뿐이라고 말하고 있다. 이에 비추어 우리나라는 아직 비만의 빈도, 비만관련 질환의 유병률, 사망률 등의 역학적 특성 및 이로 인한 사회경제적 비용에 대한 기초적인 조사조차 미흡한 상황이다. 그러나 최근 들어 비만에 대한 사회적인 관심이 고조되면서 비만을 심각한 질병으로 인식하고 비만의 예방 및 치료에 대해 우리 사회의 많은 분야에서 고민하고 대책을 마련하고자 하는 움직임이 있다는 것은 실로 다행스러운 일이다. 이제 조금씩 자리매김을 하고 있는 우리로서는 고도비만 환자의 특성 및 비만수술에 대한 홍보와 더불어 한국인에 적용되어야 할 비만수술의 적응증, 수술 방법의 평가 및 개발, 수술 술기의 표준화, 수술 전후의 환자 관리 등에 대한 체계적인 연구가 필요하리라 생각한다.
Abstract
Current evidence suggests that only bariatric surgery results in durable and substantial weight loss with resolve various comorbid medical conditions, improve quality of life, and prolong survival for patients with morbid obesity. Demand for bariatric surgery is increasing worldwide at an exponential rate. With rapid rise of morbidly obese patients, introduction of laparoscopy, use of mass media and internet to convey information to public, coverage of medical insurance might contribute to the Bariatric revolution. Bariatric surgery involve either restrictive of caloric intake or malabsorption of nutrients, or both. Bariatric surgery would bring about neurohormonal changes that affect satiety and glucose homeostasis as well. Laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass, biliopancreatic diversion with/without duodenal switch, and laparoscopic sleeve gastrectomy are the most commonly performed procedures at present. Each procedure has its advantages and disadvantages and any operative procedure cannot be thought to be predominant over another. We hope more effective, safer, and durable operative method to be developed. The author intended to provide a comprehensive overview of the current status of bariatric surgery.
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