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肥胖型2型糖尿病患者代谢手术后低碳水化合物饮食干预对体重反弹的影响 被引量:24
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作者 韩莉 王燕 邹大进 《中华内分泌外科杂志》 CAS 2019年第3期191-194,共4页
目的观察代谢手术后的肥胖型2型糖尿病患者在低碳水化合物饮食干预下的体重反弹情况。方法将2010年1月至2015年11月期间在长海医院行代谢手术的38例患者根据随机数字表法分为两组,比较行低碳水化合物(LC)饮食或糖尿病(DM)饮食干预后血... 目的观察代谢手术后的肥胖型2型糖尿病患者在低碳水化合物饮食干预下的体重反弹情况。方法将2010年1月至2015年11月期间在长海医院行代谢手术的38例患者根据随机数字表法分为两组,比较行低碳水化合物(LC)饮食或糖尿病(DM)饮食干预后血糖水平、体重反弹情况。结果 DM饮食干预组空腹血糖、糖化血红蛋白、空腹C肽、体重、腰围、BMI等干预前后的差值无统计学意义(t=0.34,S=1.00~32.5,P值均>0.05);LC饮食干预组空腹血糖、体重、腰围、BMI等干预前后的差值有统计学意义(t=2.38,S=17~24.5,P值均<0.05)。两组间比较:体重差值(Z=2.31, P<0.05)、BMI差值(Z=2.36, P<0.05)、体重反弹率的差异(P<0.05)有统计学意义,LC饮食干预组更有优势。结论代谢手术后予低碳水化合物饮食干预可改善肥胖型2型糖尿病患者空腹血糖及肥胖指标(体重、腰围、BMI);与糖尿病饮食干预比较,予低碳水合化物饮食管理,可更显著改善BMI下降幅度,减少体重反弹率及反弹幅度,能更有效控制体重反弹。 展开更多
关键词 代谢手术 肥胖型2型糖尿病 低碳水化合物饮食 体重反弹
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Outcome after gastrectomy in gastric cancer patients with type 2 diabetes 被引量:18
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作者 Jong Won Kim Jae-Ho Cheong +2 位作者 Woo Jin Hyung Seung-Ho Choi Sung Hoon Noh 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第1期49-54,共6页
AIM: To evaluate the prognosis of type Ⅱ diabetes mellitus (T2DM) after gastrectomy and related factors in gastric cancer patients. METHODS: 403 gastric cancer patients with T2DM were studied, who underwent gastrecto... AIM: To evaluate the prognosis of type Ⅱ diabetes mellitus (T2DM) after gastrectomy and related factors in gastric cancer patients. METHODS: 403 gastric cancer patients with T2DM were studied, who underwent gastrectomy between May 2003 and September 2009. A review of medica records and telephone interviews was performed in this cross-sectional study. The factors included in the statistical analysis were as follows: gender, age, type of surgery, preoperative body mass index (BMI), current BMI, BMI reduction ratio, preoperative insulin or oral diabetic medicine requirement, follow-up duration, and current state of diabetes. Assessment of diabetes status after surgery was classified into four categories according to the change in hypoglycemic agents after surgery and present status of T2DM: resolution, improvement, same, and worse.(± 20.6 mo), preoperative BMI was 24.7 kg/m2 (± 3.0 kg/m2), and BMI reduction ratio was 9.8% (± 8.6%). After surgery, T2DM was cured in 58 patients (15.1%) and was improved in 117 patients (30.4%). According to the type of surgery, the BMI reduction ratio was signif icantly higher in the total gastrectomy and Roux-en-Y reconstruction group [14.2% ± 9.2% vs 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001] and signif icantly lower in the subtotal gastrectomy and Billroth Ⅰ reconstruction group [7.6% ± 8.0%, 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001]. The BMI reduction ratio, follow-up duration after surgery, type of surgery, extent of gastrectomy, and performance of duodenal bypass were signif icantly correlated to the course of T2DM (P < 0.05). The BMI reduction ratio was the most influential factor on T2DM status. In a subgroup analysis of patients with a BMI reduction ratio of 10% or less (n = 206), T2DM was cured in 15 (7.6%) patients and was improved in 57 (28.8%) patients after surgery, and only the duration of surgery was signif icantly correlated to T2DM status (P = 0.022). 展开更多
关键词 GASTRIC CANCER Diabetes MELLITUS metabolic surgery BARIATRIC surgery
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以内科为主导多学科协作代谢手术治疗2型糖尿病的临床路径探索 被引量:19
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作者 陈静 孙芳 +12 位作者 童卫东 何洪波 闫振成 倪银星 赵志刚 刘宝华 杨建江 兰春慧 刘玉娟 毕玉田 高东 程晓斌 祝之明 《第三军医大学学报》 CAS CSCD 北大核心 2013年第9期811-815,共5页
目的探索多学科合作的手术治疗2型糖尿病的优化临床路径。方法由内分泌科、胃肠外科、消化内科、营养科及心理医生、护理人员和个案管理师组成多学科协作团队;对33例2型糖尿病患者实施胃肠转流手术,术式为胃转流术;按照一定的临床路径... 目的探索多学科合作的手术治疗2型糖尿病的优化临床路径。方法由内分泌科、胃肠外科、消化内科、营养科及心理医生、护理人员和个案管理师组成多学科协作团队;对33例2型糖尿病患者实施胃肠转流手术,术式为胃转流术;按照一定的临床路径实施术前评估、手术治疗、术后管理和长期随访。结果术后1个月主要代谢指标(包括空腹及餐后血糖、糖化血红蛋白、胰岛素抵抗指数、血脂、尿酸)、炎性标志(h-CRP)及肥胖指标(体质量、体质指数、腰围、腹部脂肪分布)与术前相比有显著改善。术后随访1年以上的患者10例,9例获得临床缓解。结论由代谢内分泌科为主导,胃肠外科为骨干,按较优化的临床路径、多学科合作手术治疗糖尿病的模式取得了较好的临床效果。 展开更多
关键词 糖尿病 肥胖 代谢手术 内科 临床路径
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从减重手术的历史看减重术式的选择 被引量:15
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作者 梁辉 吴鸿浩 《中华胃肠外科杂志》 CAS 2012年第11期1109-1111,共3页
减重手术在西方发展了50年以上。随着我国肥胖人口的增加,肥胖及2型糖尿病的手术治疗逐渐受到重视。通过回顾减重手术的历史,总结出目前适合中国国情的减重术式,包括胃旁路术、袖状胃切除术以及可调节胃绑带术等。根据患者的意愿和... 减重手术在西方发展了50年以上。随着我国肥胖人口的增加,肥胖及2型糖尿病的手术治疗逐渐受到重视。通过回顾减重手术的历史,总结出目前适合中国国情的减重术式,包括胃旁路术、袖状胃切除术以及可调节胃绑带术等。根据患者的意愿和病情,综合考虑患者的承受能力以及支持随访等条件,选择最适合的术式,方能达到最佳的减重降糖效果。 展开更多
关键词 减重外科 代谢外科 手术方式 科历史
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中国代谢外科现状与发展前景 被引量:15
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作者 刘金钢 《中华消化外科杂志》 CAS CSCD 北大核心 2015年第7期521-523,共3页
随着中国经济的快速发展,肥胖症和糖尿病已成为严重的社会性问题.代谢外科的发展在发达国家已有半个多世纪的历史,中国起步相对较晚,开展初期在手术适应证、手术方式选择及操作、并发症防治、围术期管理、术后随访等方面尚存不足.为在... 随着中国经济的快速发展,肥胖症和糖尿病已成为严重的社会性问题.代谢外科的发展在发达国家已有半个多世纪的历史,中国起步相对较晚,开展初期在手术适应证、手术方式选择及操作、并发症防治、围术期管理、术后随访等方面尚存不足.为在全国范围内规范肥胖症和2型糖尿病(T2DM)外科治疗的开展,使肥胖症和T2DM患者得到最佳的治疗,并最大限度降低相关并发症的发生率,中国医师协会外科医师分会肥胖和糖尿病外科医师委员会(CSMBS)组织国内著名专家,共同制订了《中国肥胖和2型糖尿病外科治疗指南(2014)》.该指南推出后,代谢外科手术在全国范围内迅速推广,手术数量逐年上升,尤其在手术适应证及手术方式选择方面得到进一步规范.CSMBS每年开展多场国内外学术交流活动,搭建了代谢外科医师相互交流的平台,极大促进了学科发展.笔者相信中国代谢外科发展将伴随着诊断与治疗规范、技术进步、设备更新、手术操作精细化而不断进步. 展开更多
关键词 肥胖症 糖尿病 2型 代谢外科 减肥手术 发展
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Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI,28kg/m^2:a multi-institutional study 被引量:13
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作者 Hui Liang Wei Guan +4 位作者 Yanling Yang Zhongqi Mao Yijun Mei Huan Liu Yi Miao 《The Journal of Biomedical Research》 CAS CSCD 2015年第2期112-117,共6页
Roux-en-Y gastric bypass surgery(RYGB) has been demonstrated to be successful for treating type-II diabetes2mellitus(T2DM) patients with a body mass index(BMI),30 kg/m,but reports of RYGB for T2 DM patients with... Roux-en-Y gastric bypass surgery(RYGB) has been demonstrated to be successful for treating type-II diabetes2mellitus(T2DM) patients with a body mass index(BMI),30 kg/m,but reports of RYGB for T2 DM patients with22 a BMI,28 kg/mare lacking.T2 DM patients with a BMI,28 kg/mwere prospectively recruited to participate in this study in four hospitals.The endpoint was T2 DM remission(defined by fasting blood glucose(FBG) level,110 mg/d L and hemoglobin(Hb)A1c level,6.0% at 12 months postoperatively).Predictors of remission were investigated by univariate and multivariate analyses.Eighty-six patients were assessed.Eighty-five patients underwent RYGB,with one conversion to open surgery.We compared the values of various variables before and after2 surgery.The mean BMI decreased from 24.68±2.12 to 21.72±2.43 kg/m(P,0.001).Fifty-eight(67.4%) patients were not treated by drugs or insulin after surgery,and 20 patients(23.3%) had complete remission of T2 DM at12 months after surgery with an acceptable number of complications.The mean Hb A1 c level in the remission group was significantly lower than that in the non-remission group.Patients with a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level were more likely to have T2 DM remission in multivariate2 analyses.In conclusion,RYGB was effective and safe for treating T2 DM patients with a BMI,28 kg/m.Complete remission can be predicted by cases having a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level. 展开更多
关键词 Roux-en-Y gastric bypass type 2 diabetes mellitus Hb A1c C-PEPTIDE body mass index metabolic surgery
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Recent advances in bariatric/metabolic surgery:appraisal of clinical evidence 被引量:11
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作者 Wei-Jei Lee Abdullah Almulaifi 《The Journal of Biomedical Research》 CAS CSCD 2015年第2期98-104,共7页
Obesity and associated type 2 diabetes mellitus(T2DM) are becoming a serious medical issue worldwide.Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese pa... Obesity and associated type 2 diabetes mellitus(T2DM) are becoming a serious medical issue worldwide.Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese patients.Increasing data indicates bariatric surgery as metabolic surgery is an effective and novel therapy for not well controlled obese T2 DM patients.The review of recent developments in bariatric/metabolic surgery covers 4major fields.1) Improvement of safety:recent advances in laparoscopic/metabolic surgery has made this minimal invasive surgery more than ten times safer than a decade ago.The safety profile of laparoscopic/metabolic surgery is compatible with that of laparoscopic cholecystectomy now.2) New bariatric/metabolic surgery:laparoscopic sleeve gastrectomy(LSG) is becoming the leading bariatric surgery because of its simplicity and efficacy.Other new procedures,such as gastric plication,banded plication,single anastomosis(mini) gastric bypass and Duodeno-jejunal bypass with sleeve gastrectomy have all been accepted as treatment modalities for bariatric/metabolic surgery.3)Mechanism of bariatric/metabolic surgery:Restriction is the most important mechanism for bariatric surgery.Weight regain after bariatric surgery is usually associated with loss of restriction.Recent studies demonstrated that gut hormone,microbiota and bile acid changes after bariatric surgery may play an important role in durable weight loss as well as in T2 DM remission.However,weight loss is still the cornerstone of T2 DM remission after metabolic surgery.4) Patient selection:patients who may benefit most from bariatric surgery was found to be patients with insulin resistance.For Asian T2 DM patients,the indication of metabolic surgery has been set to those with not well2controlled(Hb A1 c.7.5%) disease and with their BMI.27.5 Kg/m.A novel diabetes surgical score,ABCD score,is a simple system for predicting the success of surgical therapy for T2 DM. 展开更多
关键词 bariatric surgery metabolic surgery type 2 diabetes mellitus ADVANCES
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The success of sleeve gastrectomy in the management of metabolic syndrome and obesity 被引量:11
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作者 Asim Shabbir Dallan Dargan 《The Journal of Biomedical Research》 CAS CSCD 2015年第2期93-97,共5页
The rapid reversal of diabetes,hypertension,hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic syndrome.Sleeve gastrectomy,which developed initially a... The rapid reversal of diabetes,hypertension,hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic syndrome.Sleeve gastrectomy,which developed initially as a preparatory procedure for biliopancreatic diversion with duodenal switch,has seen an exponential rise in popularity as an effective lone laparoscopic bariatric procedure.Superior excess weight loss,a low complication rate,and excellent food tolerance,combined with a short hospital stay,have made this the procedure of choice for patients and surgeons across the globe.High volume centres nurture the ongoing development of experienced and specialized teams,pathways and regimens.Optimum surgical outcomes allow minimization of metabolic syndrome,reducing cardiovascular and cerebrovascular risk. 展开更多
关键词 metabolic surgery sleeve gastrectomy diabetes mellitus OBESITY
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代谢手术对肥胖与非肥胖2型糖尿病患者体质指数、胰岛素抵抗及血脂影响 被引量:12
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作者 孙芳 闫振成 +4 位作者 陈静 倪银星 高羽 童卫东 祝之明 《第三军医大学学报》 CAS CSCD 北大核心 2013年第9期820-823,共4页
目的比较代谢手术对肥胖与非肥胖2型糖尿病患者术后体质指数(BMI)及代谢指标的总体效果差异。方法以体质指数28为切点,分为肥胖糖尿病组(BMI≥28 kg/m2,n=10)及非肥胖糖尿病组(BMI<28 kg/m2,n=10),术前配比各项基础资料,术后3~6个... 目的比较代谢手术对肥胖与非肥胖2型糖尿病患者术后体质指数(BMI)及代谢指标的总体效果差异。方法以体质指数28为切点,分为肥胖糖尿病组(BMI≥28 kg/m2,n=10)及非肥胖糖尿病组(BMI<28 kg/m2,n=10),术前配比各项基础资料,术后3~6个月随访体质指数、葡萄糖耐量及胰岛素释放、尿酸、总胆固醇、低密度脂蛋白胆固醇水平,比较各组手术前后的差异以及两组术后效果的差异。结果相关分析发现非肥胖患者(BMI<28 kg/m2)术后BMI下降程度与术前BMI无相关(r=0.416,P=0.232),而肥胖患者(BMI≥28 kg/m2)术后BMI下降程度则与术前BMI高低明显相关(r=0.932,P<0.001)。非肥胖患者与肥胖患者手术前后胰岛素抵抗程度、总胆固醇水平均明显改善(P<0.05),而尿酸代谢、低密度脂蛋白胆固醇水平均无明显变化。两组患者术后在体质指数的下降程度差异明显,肥胖患者较非肥胖患者下降更明显,而两组患者术后在胰岛素抵抗、总胆固醇水平的改善程度上并无显著性差异。结论代谢手术能明显改善肥胖与非肥胖糖尿病患者术后体质量、胰岛素抵抗及血脂,且非肥胖2型糖尿病患者与肥胖2型糖尿病患者术后总胆固醇、低密度脂蛋白及胰岛素抵抗改善获益相当,肥胖与否不能作为是否手术的绝对指征。 展开更多
关键词 糖尿病 代谢手术 肥胖 体质指数 胰岛素抵抗
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弗洛伊德精神分析疗法对行代谢手术治疗的2型糖尿病患者疾病不确定性及焦虑的影响 被引量:12
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作者 孟宪云 吴松岭 王辉 《临床与病理杂志》 2020年第11期2939-2944,共6页
目的:探讨弗洛伊德精神分析疗法对行代谢手术治疗的2型糖尿病患者疾病不确定性及焦虑的影响。方法:选取首都医科大学附属北京天坛医院普外科于2017年3月至12月收治的30例采用代谢手术治疗的2型糖尿病患者,设为对照组,采用常规护理。选... 目的:探讨弗洛伊德精神分析疗法对行代谢手术治疗的2型糖尿病患者疾病不确定性及焦虑的影响。方法:选取首都医科大学附属北京天坛医院普外科于2017年3月至12月收治的30例采用代谢手术治疗的2型糖尿病患者,设为对照组,采用常规护理。选取同科室于2018年1月至10月收治的30例采用代谢手术治疗的2型糖尿病患者,设为观察组,在对照组的基础上采用弗洛伊德精神分析疗法。回顾性分析两组的临床资料。采用疾病不确定感量表(Mishel Uncertainty in Illness Scale,MUIS)评价患者手术的不确定性,医院焦虑自评量表(Self-rating Anxiety Scale,SAS)评价患者的焦虑情绪,并调查患者的访视满意度。结果:观察组MUIS和SAS评分均低于对照组,差异均有统计学意义(均P<0.05)。观察组的安全需求、业务素质、手术信息需求等访视满意度较高,两组相比差异有统计学意义(P<0.05)。结论:弗洛伊德精神分析疗法能增加2型糖尿病代谢手术患者的手术认知,减轻患者对手术治疗的不确定感和焦虑情绪,提高访视满意度。 展开更多
关键词 弗洛伊德精神分析疗法 代谢手术 2型糖尿病 焦虑 疾病不确定性
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肥胖症与2型糖尿病的外科治疗机制研究进展 被引量:11
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作者 傅涛 金炜东 《中华普外科手术学杂志(电子版)》 2020年第6期639-642,共4页
外科手术治疗肥胖症和2型糖尿病正在成为治疗代谢疾病的最有效治疗措施之一。在外科领域不断地尝试探索中,陆续出现了多种代谢外科手术方式。各种减重手术对肥胖及其相关代谢并发症均有较好的改善,肥胖症与很多慢性疾病相关,比如2型糖... 外科手术治疗肥胖症和2型糖尿病正在成为治疗代谢疾病的最有效治疗措施之一。在外科领域不断地尝试探索中,陆续出现了多种代谢外科手术方式。各种减重手术对肥胖及其相关代谢并发症均有较好的改善,肥胖症与很多慢性疾病相关,比如2型糖尿病、阻塞性睡眠呼吸暂停综合征、高血压病、血脂异常相关心血管疾病(心肌梗塞、中风)、非酒精性脂肪肝、多囊卵巢综合征、骨关节炎、不孕不育等,在减重手术后代谢综合症短期内即可得以有效缓解或治愈。但此类手术机制目前尚不十分明确,各种假说针对包括术后热卡摄入减少、胃肠道激素改变或前肠-后肠理论、血清胆汁酸与肠道细菌菌群的改变等机制进行探讨,但都并不能完全解释不同减重手术方式都能改善代谢综合征的原因,但相信在未来,随着大宗临床数据研究报告支持以及作用机制研究的进一步深入,了解调控机制,进行精确的对因治疗,可更好的让患者获益。 展开更多
关键词 肥胖症 糖尿病 2型 代谢手术 减肥手术 机制研究
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减重外科的发展历程及前景 被引量:11
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作者 李威杰 《中华消化外科杂志》 CAS CSCD 北大核心 2013年第12期891-893,共3页
随着肥胖问题的日益严重以及微创减重手术的发展,减重手术在近年来呈现跳跃式的发展,也发展出独立的减重外科分支。减重手术不但是病态性肥胖患者目前唯一有效的治疗方法,而且逐渐发展为代谢性手术,为难治性的肥胖合并糖尿病患者提... 随着肥胖问题的日益严重以及微创减重手术的发展,减重手术在近年来呈现跳跃式的发展,也发展出独立的减重外科分支。减重手术不但是病态性肥胖患者目前唯一有效的治疗方法,而且逐渐发展为代谢性手术,为难治性的肥胖合并糖尿病患者提供了一种新的治疗方法。减重手术的术式数十年发生了很大的变化,目前的减重手术经过不断的改进及发展,已成为一种相对安全和有效的外科治疗方法。新的代谢性手术仍在不断地发展,预期对未来糖尿病的治疗会有很大的突破。减重外科的专科化发展则是减重手术蓬勃发展后的必然趋势,独立的减重外科可以专注于减重手术的服务以及质量提升,对减重及代谢手术的专业训练以及研究发展也都有很大的帮助。随着文明化生活方式的影响,肥胖及糖尿病将会持续成为这个时代重要的健康问题,减重外科的发展更是值得期待。 展开更多
关键词 肥胖症 糖尿病 2型 减肥手术 代谢手术
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Five Year Follow up after Surgical Treatment of Type 2 Diabetes with Laparoscopic Sleeve Gastrectomy Associated with a Duodenal Ileal Interposition
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作者 Augusto Cláudio de Almeida Tinoco Matheus Paula da Silva Netto +2 位作者 Henrique Benedito Aureo Ludovico DePaula Luciana Janene El-Kadre 《Surgical Science》 2024年第6期396-408,共13页
Introduction: Type 2 diabetes mellitus (T2D) is a chronic disease, primarily caused by a combination of defective insulin secretion and the inability of insulin-sensitive tissues to respond to insulin. Laparoscopic sl... Introduction: Type 2 diabetes mellitus (T2D) is a chronic disease, primarily caused by a combination of defective insulin secretion and the inability of insulin-sensitive tissues to respond to insulin. Laparoscopic sleeve gastrectomy associated with duodenal ileal interposition (SGDII) has been shown to be a feasible treatment option for patients with T2D, as it provides improvement and control of glycemia, dyslipidemia and arterial hypertension. The aim of this study was to evaluate the mid and long-term results of SGDII for the treatment of diabetic patients, considering diabetic remission, weight loss and postoperative complications. Materials and Methods: Retrospective study with 96 patients with T2D submitted to SGDII, between 2010 and 2016. The glycated hemoglobin (HbA1c) value Results: Sixty-one patients (62.8%) were male, and 36 patients (37.2%) were female. The average age was 50.9 years. Median BMI was 33.43 kg/m2. The incidence of major postoperative complications in the first 30 days was 2.1%, with no mortality. Dyslipidemia control was sustained, after five years, in 62% of the patients. The five years follow-up demonstrated that 80% of patients had T2D remission at one year, 74.5% at three years and 61.8% at five years. Univariate analysis demonstrated that preoperative values of HbA1c and BMI, preoperative use of insulin, gender, and 30-day complication were not predictors of remission at all study intervals. The average duration of the disease was nine years and the mean glycated hemoglobin before surgery was 8.95%. Conclusion: SGDII resulted in good glycemic control at 5-years follow-up and represents a valid alternative for the treatment of T2D. 展开更多
关键词 DIABETES surgery metabolic Syndrome DYSLIPIDEMIA Ileal Interposition metabolic surgery Bariatric surgery OBESITY
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非酒精性脂肪肝和减重 被引量:10
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作者 平凡 李玉秀 《中国医学科学院学报》 CAS CSCD 北大核心 2018年第5期597-602,共6页
非酒精性脂肪肝病(NAFLD)是指排除了其他已知原因(如大量的酒精摄入或肝炎病毒感染)的肝脏脂肪样变,在全球范围内已成为广泛的危害健康的慢性疾病且流行趋势进行性扩大。肥胖主要通过肝脏的胰岛素抵抗导致三酰甘油在肝脏的沉积,从而促进... 非酒精性脂肪肝病(NAFLD)是指排除了其他已知原因(如大量的酒精摄入或肝炎病毒感染)的肝脏脂肪样变,在全球范围内已成为广泛的危害健康的慢性疾病且流行趋势进行性扩大。肥胖主要通过肝脏的胰岛素抵抗导致三酰甘油在肝脏的沉积,从而促进NAFLD的发生发展。减轻体质量是唯一有充分证据显示对NAFLD安全有效的方法。生活方式干预在NAFLD的治疗中有着基石地位,但大多数肥胖的患者仅通过生活方式干预很难达到并维持理想体质量的状态。减重药物中的胰高血糖素样肽类似物及代谢手术都是治疗NAFLD较有前景的方法。 展开更多
关键词 肥胖 非酒精性脂肪肝 胰高血糖素样肽-1类似物 代谢手术
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肥胖及超重2型糖尿病患者代谢手术后5年疗效随访研究 被引量:9
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作者 李东玲 陈小燕 +1 位作者 黄炯强 柯传烽 《中国糖尿病杂志》 CAS CSCD 北大核心 2022年第2期101-105,共5页
目的探讨肥胖及超重T2DM患者代谢手术后5年疗效。方法采用前瞻性病例自身前后对照法,对接受代谢手术满5年且随访资料完整的38例肥胖及超重T2DM患者进行疗效分析,观察术后代谢指标、DM缓解率和并发症变化。结果患者代谢手术后第1~5年,体... 目的探讨肥胖及超重T2DM患者代谢手术后5年疗效。方法采用前瞻性病例自身前后对照法,对接受代谢手术满5年且随访资料完整的38例肥胖及超重T2DM患者进行疗效分析,观察术后代谢指标、DM缓解率和并发症变化。结果患者代谢手术后第1~5年,体重、BMI、WC、FPG、HbA1c、FIns、FC-P、胰岛素抵抗指数(HOMA-IR)、LDL-C较术前降低(P<0.05)。将14例T2DM患者分为术后5年完全缓解组(CR,缓解率为42.9%)和部分缓解及无效组(Con)。与Con组比较,CR组术前FIns(t=-2.33,P=0.038)、HOMA-IR(t=2.82,P=0.016)、FC-P(t=4.73,P=0.000)、BMI(t=3.07,P=0.01)较高,年龄低(t=-2.33,P=0.038),DM病程短(t=-4.04,P=0.002)。术后5年脂代谢异常、高血压病、阻塞性睡眠呼吸暂停综合征缓解率分别为55.2%、60.0%、64.3%。结论肥胖及超重T2DM患者实施代谢手术,可持续有效控制体重,改善各项代谢指标及减少多种并发症。T2DM长期缓解可能与术前胰岛功能、IR程度、DM病程、BMI和年龄相关。 展开更多
关键词 代谢手术 肥胖 糖尿病 2型
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规范与务实——促进我国肥胖症与代谢病外科的健康发展 被引量:10
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作者 王存川 翟贺宁 《中华胃肠外科杂志》 CAS 2012年第11期1102-1105,共4页
经过半个多世纪的发展,肥胖症与代谢病外科在西方国家已经形成了一个体系完整的外科专业,而我国引入并开展该学科仅10余年时间。外科治疗肥胖症与相关代谢性疾病,尤其是肥胖型2型糖尿病已得到我国同行和患者的极大兴趣与认可。作为... 经过半个多世纪的发展,肥胖症与代谢病外科在西方国家已经形成了一个体系完整的外科专业,而我国引入并开展该学科仅10余年时间。外科治疗肥胖症与相关代谢性疾病,尤其是肥胖型2型糖尿病已得到我国同行和患者的极大兴趣与认可。作为一个新的发展方向,目前我国肥胖症与代谢病外科总的发展趋势良好,但也存在一些问题,如手术名称不够规范、随意放宽手术适应证、对手术方式进行随意更改、疗效评价标准混乱以及术后随访资料不齐等。这些都需要广大同行根据我国实际情况,科学而客观地进行规范,从而促进我国肥胖症与代谢病外科的健康发展。 展开更多
关键词 肥胖症 代谢病外科 减重手术 规范化
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Application of side-to-side anastomosis of the lesser curvature of stomach and jejunum in gastric bypass 被引量:7
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作者 Ri-Xing Bai Wen-Mao Yan +3 位作者 You-Guo Li Jun Xu Zhi-Qiang Zhong Ming Yan 《World Journal of Gastroenterology》 SCIE CAS 2016年第37期8398-8405,共8页
AIM To evaluate the feasibility of side-to-side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic Roux-en-Y gastric bypass(LRYGB).METHODS Seventy-seven patients received side-to-side anastomos... AIM To evaluate the feasibility of side-to-side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic Roux-en-Y gastric bypass(LRYGB).METHODS Seventy-seven patients received side-to-side anastomosis of the lesser curvature of stomach and jejunum by utilization of linear stapler in LRYGB from April 2012 to July 2015 were retrospectively analyzed.RESULTS All patients were successfully completed laparoscopic gastric bypass with the side-to-side anastomosis of the lesser curvature of stomach and jejunum. No patient was switched to laparotomy during operation. No early complications including gastrointestinal anastomotic bleeding, fistula, obstruction, deep vein thrombosis, incision infections, intra-abdominal hernia complications were found. One patient complicated with stricture of gastrojejunal anastomosis(1.3%) and six patients complicated with incomplete intestinal obstruction(7.8%). BMI and Hb A1 c determined at 3, 6, 12, 24 mo during follow up period were significantly reduced compared with preoperative baselines respectively. The percentage of patients who maintain HbA 1c(%) < 6.5% without taking antidiabetic drugs reached to 61.0%, 63.6%, 75.0%, and 63.6% respectively. The outcome parameters of concomitant diseases were significantly improved too.CONCLUSION Present surgery is a safety and feasibility procedure. It is effective to lighten the body weight of patients and improve type 2 diabetes and related complications. 展开更多
关键词 Laparoscopic Roux-en-Y GASTRIC BYPASS GASTRIC BYPASS GASTROJEJUNOSTOMY metabolic surgery BARIATRIC surgery Type 2 diabetes mellitus
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基于加速康复的代谢手术围手术期营养管理研究进展 被引量:9
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作者 张天资 许勤 +2 位作者 杨宁硎 汤娟 梁辉 《中华胃肠外科杂志》 CAS CSCD 北大核心 2017年第4期477-480,共4页
代谢手术是治疗肥胖及相关合并症的一种胃肠外科手术类型,近年来发展迅速。代谢手术患者术前即存在营养问题.该人群的营养管理是围手术期管理的重点。在围手术期,已有的研究充分应用ERAS理念,针对代谢手术人群的特点开展了相关探讨... 代谢手术是治疗肥胖及相关合并症的一种胃肠外科手术类型,近年来发展迅速。代谢手术患者术前即存在营养问题.该人群的营养管理是围手术期管理的重点。在围手术期,已有的研究充分应用ERAS理念,针对代谢手术人群的特点开展了相关探讨,初步证实了各项围手术期措施在临床实践中应用的安全性及有效性,包括:微量营养素的缺乏与补充,术前减重效果的探究,以及术前空腹及口服碳水化合物等。在术后饮食策略中,现有文献对营养管理的阶段界定及营养管理内容尚未统一,国内有关代谢手术围手术期营养管理的报道较少,且现有文献中营养管理实施的具体内容还存在分歧,尚缺乏统一、完善的参考标准,有必要形成规范的营养管理路径,为临床代谢手术围手术期营养管理的实施提供相关依据与参考。 展开更多
关键词 加速康复外科 代谢手术 围手术期 营养管理
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寻求并接受代谢手术患者的心理健康状况及相关因素 被引量:9
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作者 吕蒙蒙 马西文 +3 位作者 贺荟茜 胡扬喜 高磊 刘栋 《中国心理卫生杂志》 CSSCI CSCD 北大核心 2020年第2期99-105,共7页
目的:了解寻求并接受代谢手术患者的心理健康现状,探讨内在化歧视、应对方式及社会支持与心理健康的关系。方法:选取到郑州市某三级甲等医院胃肠疝外科寻求并接受代谢手术治疗的患者107例。采用Kessler10量表(K10)评估患者的心理健康状... 目的:了解寻求并接受代谢手术患者的心理健康现状,探讨内在化歧视、应对方式及社会支持与心理健康的关系。方法:选取到郑州市某三级甲等医院胃肠疝外科寻求并接受代谢手术治疗的患者107例。采用Kessler10量表(K10)评估患者的心理健康状况,采用内在化歧视量表(WBIS)、医学应对方式问卷(MCMQ)及社会支持评定量表(SSRS)评估患者的肥胖病耻感、应对方式和社会支持水平。结果:患者的K10得分为(20.5±6.4)分,K10得分≥22分的患者占34.6%;女性患者的K10、WBIS得分均高于男性患者(均P<0.05)。回归分析表明,WBIS得分及MCMQ面对应对、屈服应对得分均与K10得分正向关联(β=0.20~0.48,均P<0.05),SSRS社会支持利用度得分与K10得分负向关联(β=-0.44,P<0.05)。结论:寻求并接受代谢手术患者的整体心理健康水平一般,部分患者的心理健康状况差;心理健康状况与内在化歧视、应对方式及社会支持相关。 展开更多
关键词 代谢手术 心理健康 因素分析
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Sleeve Gastrectomy with Duodenal Transit Bipartition (S-DTB): Preliminary Results and Technical Aspects of Its Metabolic Structure
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作者 Paulo Reis Esselin de Melo Ricardo Zorron +5 位作者 Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Rui Ribeiro Thonya Cruz Braga Paula Volpe Carlos Eduardo Domene 《Surgical Science》 2024年第4期244-264,共21页
Obesity is a significant and escalating health issue both in Brazil and globally, with over 650 million overweight adults worldwide. The treatment of obesity can be performed clinically, endoscopically or surgically;s... Obesity is a significant and escalating health issue both in Brazil and globally, with over 650 million overweight adults worldwide. The treatment of obesity can be performed clinically, endoscopically or surgically;surgical treatment proves to be safe and more effective in terms of weight loss and long-term maintenance. Objective: This study aimed to monitor the progress of weight loss and comorbidity control in patients undergoing sleeve gastrectomy with duodenal bipartition. Methods: This pilot project involved 8 patients divided into 2 arms. In the first arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenoileal transit bipartition (S-RYDITB), while in the second arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenojejunal transit bipartition (S-RYDJTB). Both procedures involved Roux-en-Y reconstruction without duodenal exclusion. In S-RYDITB, the duodenal-ileal anastomosis was performed 300 cm from the ileocecal valve (ICV), creating a 250 cm common channel and a 50 cm alimentary channel. In S-RYDJTB, a biliopancreatic loop was created 200 cm from the angle of Treitz, with a 1 m alimentary channel. Results: Five patients underwent the procedures, with one undergoing S-RYDITB and four undergoing S-RYDJTB. No adverse events such as hospitalizations, readmissions, reoperations, fistulas, bleeding, pulmonary embolism, diarrhea, dumping syndrome, or hypoglycemia occurred during the study period. The mean length of hospital stay was 2 days. The average BMI decreased from 37.27 kg/m<sup>2</sup> preoperatively to 29.48 kg/m<sup>2</sup> after 6 months. The significant percentage of weight loss was 21.22%, with excess weight loss of 63.6%. Ninety-five percent remission of comorbidities, including hypercholesterolemia, hypertriglyceridemia, diabetes, hypertension, steatosis, and pre-diabetes. Two patients underwent sleeve gastrectomy with duodenal bipartition using a single anastomosis. Conclusion: Duodenal switch surgery has gained worldwide recognition for its safety and efficacy in treating o 展开更多
关键词 OBESITY Bariatric surgery metabolic surgery Duodenal Switch
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