摘要
随着肥胖症和2型糖尿病（T2DM）患者数量在全球范围内的增长，减重代谢外科学快速发展成为一门亚专科。然而目前减重代谢外科在手术适应证、获益和潜在风险等方面仍存在争议。2015年9月，第2届糖尿病外科峰会（DSS-Ⅱ）发布了关于糖尿病外科治疗的全球联合声明，作为减重代谢外科治疗T2DM的最新临床指南。该指南经美国糖尿病学会（ADA）、国际糖尿病联合会（IDF）、中华医学会糖尿病分会（CDS）、印度糖尿病学会（DiabetesIndia）和英国糖尿病学会（DiabetesUK）这5个全球主流糖尿病学术组织讨论，并由来自全球不同国家的48位专家组成的投票委员会参与决定．已获得来自全球的30个非外科专业学会和15个外科专业学会的支持。该指南对减重代谢外科学与传统减重外科进行了区分，提出以下6点：（1）减重代谢外科学的目的是“治疗T2DM，控制T2DM并发症的风险”。（2）除多余体质量减少率（％EWL）〉50％和血糖恢复正常外，糖尿病相关并发症的结局也应划入减重代谢手术临床结局判定标准。（3）对手术患者的选择应考虑体质指数（BMI）、T2DM治疗以及手术长期风险与获益的平衡[包括心血管事件（CVD）]。（4）术前准备时应该准确诊断糖尿病以及评估糖尿病并发症。并应该评估胰腺分泌功能储备。（5）减重代谢手术方式多样，包括腹腔镜胃旁路术（LRYGB），腹腔镜胃袖状切除术（LSG），腹腔镜可调节胃绑带术（LAGB）以及胆胰分流-十二指肠转位术（BPD-DS），对于糖尿病治疗结局的优劣依次为BPD-DS、RYGB、LSG和LAGB。（6）术后应严密监测血糖变化并控制血糖，2年内应该至少每6个月接受1次随访。对于T2DM完全缓解的患者，术后5年以内应该按照术前的频率和方式监测糖尿病并发症。
Along with the soaring prevalence of obesity and type 2 diabetes mellitus （T2DM） globally, metabolic and bariatrie surgery （MBS） has been rapidly developing into a major surgical subspecialty. However, the indications, benefits and potential risks of MBS are still controversial so far. In September 2015, the 2nd Diabetes Surgery Summit （DSS-Ⅱ ） was successfully convened, and later on an international joint statement on metabolic surgery in the treatment algorithm for T2DM was released based upon the consensus reached in DSS-Ⅱ , aiming to serve as a new global clinical guideline. The DSS-Ⅱ joint statement was initiated and endorsed by 5 leading international diabetes organizations, including American Diabetes Association （ADA）, International Diabetes Federation （IDF）, Chinese Diabetes Society （CDS）, Diabetes India, as well as Diabetes UK, and was developed by an expert committee comprised of 48 international authorities as voting delegates. Up to the date of publication, the DSS-lI statement has been officially endorsed by 45 international professional associations/societies, including 30 non-surgical and 15 surgical organizations. In this statement, the following six aspects were recommended to differentiate MBS from traditional bariatric surgery： 1）The primary goal of MBS is to treat T2DM and to reduce the risk of T2DM complications; 2）In addition to a 50% or more of excess weight loss and normalization of glycemia, outcomes of diabetes complications should also be considered as clinical endpoints of MBS; 3） For patient selection, body mass index （BMI）, T2DM treatment, as well as long-term risks versus benefits, including its effects on cardiovascular events （CVD）, should all be considered; 4） T2DM and its complications, as well as pancreatic function reserve should be assessed pre-operatively; 5） Major surgical options include laparoscopic Roux-en-Y gastric bypass （LRYGB）, laparoscopic sleeve gastrectomy （LSG）, laparoscopic adjustable gastric banding （
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第4期372-377,共6页
Chinese Journal of Gastrointestinal Surgery
基金
浦东新区卫生系统学科带头人培养计划（pwrd2013-08）
浦东新区卫生系统重点学科群建设资助（pwzxq2014-08）
关键词
2型糖尿病
减重代谢外科
指南
Type 2 diabetes mellitus
Metabolic and bariatric surgery
Guideline
