国外糖尿病手术的发展现况

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1、国外糖尿病手术发展现况由减重手术到糖尿病手术以减重手术治疗糖尿病胃肠道代谢手术(Gastro-intestinalMetabolicsurgery)病人的选择Nature2000;404,635-43减重手术在美国已是最常见的胃肠道手术生命不可承受之重UnbearableweightinlifeObesityCo-morbiditiesMechanicalMetabolic.ObstructiveSleepApnea.HypoventilationSyndrome.Osteoarthritis.StasisDermatitis.

2、HeartFailure.Incontinence.QualityofLife.Diabetes.Cardiovascular.Gallstone.NASH.Gout.Cancer.PCOSPsycho-Social.Psychologic：Lossself-confidenceSocial:FreindMarriageJob,PromotionBMI与死亡率的关系Mortalitylowestat22.5-2530%higherateach5BMIhigher40%vascular60-120%DM,renalandhepat

3、ic10%MalignancyLancet.2009March28;373(9669):1083-1096JAMA1999减重手术是严重肥胖最有效的治疗方法EffectofBariatricSurgeryonMortalityinSwedishObeseSubjectsLarsSjostrometal.NEnglJMed2007:357:741-52减重手术对瑞典病人死亡率的影响EffectofBariatricSurgeryonMortalityinSwedishObeseSubjectsLarsSjostrometal.NE

4、nglJMed2007:357:741-52Unadjustedoverallmortalitywasreducedby24.6%(p=0.0346)Adjustedriskreductionwas31.6%(p=0.00083)Mortalitydifferencewasmainlyattributabletoreductionsincoronaryeventsandcancers.胃绕道手术对长期死亡率的影响Long-termmortalityaftergastricbypasssurgery7925surgicalvs.7

5、925matchedcontrol,follow-up7.1yAdecreaseof40%mortality56%forcoronaryarterydisease92%fordiabetes60%forcancerAincreaseof58%ofdeathnotcausedbydisease,suchasaccidentsandsuicideAdamsTDetal.NEJM2007;357:753-61由减重手术到糖尿病手术以减重手术治疗糖尿病胃肠道代谢手术(Gastro-intestinalMetabolicsurgery)病

6、人的选择Whowouldhavethoughtit?Anoperationprovestobethemosteffectivetherapyforadult-onsetdiabetesmellitusPoriesWJ,SwansonMS,MacDonaldKG,etal.AnnSurg1995;222:339-350在肥胖病人，减重手术可长期根治糖尿病BariatricSurgeryASystematicReviewandMeta-analysisBuchwaldH.etal.JAMA2004:292:1724-1737Con

7、clusioneffectiveweightlosswasachievedinmorbidlyobesepatientsafterundergoingbariatricsurgery.AsubstantialmajorityofwithDiabetes,Hyperlipidemia,HypertensionandObstructivesleepapneaexperiencedcompleteresolutionorimprovement.不同减重手术对糖尿病的治疗效果HealthOutcomesofSeverelyObeseTy

8、pe2DiabeticSubjects1YearAfterLaparoscopicAdjustableGastricBanding500besepatients(BMI48.2+8Kg/M2)withtype2diabetesRemissionofT2DMwas