Ojiji nke oria bariatric maka oria abuo mellitus: inye aka dibia bekee Nkpako nke ihe omuma sayensi di na ogwu - Ogwu na Ahụike.

Dabere na WHO, ọnụ ọgụgụ ndị nọ n'ụwa bụ oke ibu na 2014 karịrị nde 600, na oke ibu - ijeri 1.9. A na-eme atụmatụ na T2DM zuru ụwa ọnụ na 9% n'etiti ndị okenye karịa afọ 18 na WHO buru amụma na ọrịa shuga ga-abụ ọnụọgụ nke 7 na-akpata ọnwụ na 2030 (* www.who.int /). Anyi n’eme ka ị mata banyere echiche ezighi ezi metụtara ọgwụgwọ nke oke ibu na ọrịa shuga.

Ibu oke ibu bụ nsogbu mba ndị mepere emepe, ọ bụghị Russia

Ọ dịghị ka nke ahụ n'ezie. N'ezie oke ibu na mba ndị mepere emepe bụ nnukwu nsogbu ugbu a. Mana enwere otu ihe. Oké ibu na mba ndị mepere emepe na-emetụta otu akụkụ nke ndị bi na-enwe ntakịrị ego. N'ọnọdụ mmebi nke ihe onwunwe, ọnụọgụgụ mmadụ na-eri nri dị ala na protein yana ọnụ ọgụgụ buru ibu a na-akpọ carbohydrates dị ọnụ ala. Ọ bụ ihe nwute, taa Russia na - ejikọ mba ndị mepere emepe n'ihe gbasara oke ibu oke ibu na, yabụ, T2DM.

Taa, ọ bụ mmadụ ole na ole na-achọpụta oke ibu dịka nsogbu ahụike.

Onu ogugu ndi mmadu kariri, ma obu ihe nwute, ndi ulo oru ahu ike choputara oke ibu na oke ibu dika ihe di nma, ihe ntecha, ezi na ulo, ma obughi ya bu nsogbu ahu ike. Ọzọkwa, echiche na-ezighị ezi ọdịnala nke na-ejikọta "ndị ukwu" na agụụ "agụụ, yana nwata, ka bụ ihe a na-ahụkarị. Taa, mmata na ọrụ nke ngalaba ahụike, ọkachasị ndị ọrụ "ọkwa-mbụ", ezughi oke.

N’agbanyeghi eziokwu na ịwa ahụ maka oke ibu karịa afọ 60, ozi gbasara ụdị ọgwụgwọ a dị mwute ikwu na akụkụ nke obere ndị ọkachamara ka nwere ya.

Ka o sina dị, n'ihi ịdị elu ya na ọgwụgwọ oke, ụdị shuga mellitus 2, dyslipidemia, ịwa ahụ bariatric bụ mpaghara kachasị na-emepe emepe, mana mkparịta ụka nke nsonaazụ na nsonaazụ ka bụ ihe ndị ọkachamara nkwukọrịta nke ndị ọkachamara "warara" ma dịka iwu adịghị agabiga na nnọkọ sayensị. Ndị nwere oke oke oke anaghị enwekarị ọmịiko n'ime ọha mmadụ na nchegbu ọkachamara na ịchọ inye aka. Kama nke ahụ, ọtụtụ mgbe ndị a na-abụ ndị a na-ekwukarị ma ọ bụ kpasuo iwe. Ọ ga-ahụrịrị na site na-abawanye na oke nke oke ibu, ọnọdụ nke ọrịa shuga na-abawanye.

Ọ dịkwa mkpa ikwu na, dị ka ndị ọkachamara si kwuo, ihe karịrị ọkara nke ndị ọrịa nwere T2DM bụ ndị na-enyochabeghị.

Nke ahụ bụ, ụdị a, nke amabeghị banyere ọrịa ahụ, mana megide ndabere nke metabolism metabolism na-akpata, mmebi vaskụla na-eme, na-eduga mgbe ahụ na mmepe nke ọrịa angiopathy na mbibi arịa nke obi, ụbụrụ, nsọtụ ala, akụrụ, na retina.

Ọrịa shuga 2dị nke Abụọ bụ ọrịa na-enweghị ọgwụgwọ

N’ezie, T2DM ka atulere oge niile ọrịa na-enweghị ike ịrịa ọrịa na-enweghị ike. Nkwupụta a dabara adaba. Ya bụ, maka ndị ọrịa na-anata ọgwụgwọ na-achọghị mgbanwe.

Na-emegide usoro ọgwụgwọ na-achọghị mgbanwe, nsonaazụ ọgwụgwọ kachasị bụ ụgwọ maka T2DM - nke ahụ bụ, inweta ọnọdụ ọ ga - ekwe omume iweta ọkwa glucose nso na enyemaka maka usoro ọgwụgwọ dị iche iche, ọkachasị, ị ofụ ọgwụ na - ebedalata shuga yana nri.

Anyị nwere ike ịsị na nsonaazụ nke nchọpụta afọ 14 nke ndị ọrịa nwere ụdị shuga 2, nke e bipụtara na 1995, ghọrọ ụdị ngagharị na ọgwụgwọ nke ụdị ọrịa shuga 2 nke ọrịa mellitus, nke na-egosi ịdị ogologo oge nke ọkwa nke glycemia na-enweghị iji ọgwụ na-ebelata shuga. Ihe omuma site na puku kwuru ihe gosiri na mgbe imechara mgbatịcha agbatịkwu ogologo oge, ihe karịrị 76% ndị ọrịa nwere T2DM ruru.

Onye ọ bụla nwere ike belata oke ibu, o zuru ezu igbochi onwe ya na nri ma nwekwaa mmega ahụ.

A pụrụ ịchịkwa ibu ibu n’ezie site n’usoro nri na ụdị ndụ. Ma iwu a na-arụ ọrụ naanị ruo oge ụfọdụ. Ihe bụ́ nsogbu bụ na ụkpụrụ bụ isi nke iwelata oke anụ ahụ “na-eri obere ihe, kwaga karịa” na oke ibu n'ọtụtụ oge anaghị arụ ọrụ na ya, ebe ọ bụ na nri nri anọwo na-etolite kemgbe ọtụtụ afọ na ọtụtụ ndị ọrịa enweghị ike ịme onwe ha. merie.

Ka ịba ụba nke ahụ na-abawanye, ọ na - akpaghasị metabolism, anụ ahụ na - ewepụta aru aru na - ewepụta ọtụtụ homonụ nke ya ma si otú a malite ịkọwa mkpa na ịchịkwa akparamagwa mmadụ.

Nsonaazụ nleba anya ogologo oge nke nnukwu njikọ ndị ọrịa na-egosi na ọ dịghị ihe karịrị 10% nke ndị ọrịa buru ibu nwere ike nweta nsonaazụ ọgwụgwọ achọrọ megide ndabere nke usoro ọgwụgwọ ọdịnala. N’agbanyeghi ihe mmemme iri-uru dị iche iche, gụnyere ọgwụ nri, ọgwụ ọgwụ na mmega ahụ, n’ime afọ iri, ọ bụghị naanị iwetulata ahụ, mana mmụba nke 1.6-2%.

Surgerywa ahụ Bariatric bụ ịwa ahụ (ịchọ mma) ma chọọ ime ka ọdịdị onye ọrịa dị mma

Echiche nke ụzọ enwere ike isi rụọ ọrụ ịgwọ ọrịa oke na uche ndị ọrịa ma ọ dị mwute ikwu na ọtụtụ ndị dọkịta na-esonyere ịwa ahụ plastik iji wepụ abụba dị ka liposuction, abdominoplasty. Nke a abụghị eziokwu. Abụba gabigara ókè bụ ihe ọzọ na-akpata metabolism na-ewepụ ya na iwepụ akụkụ ya anaghị ewepụ ihe kpatara nsogbu ahụ.

N’adịghị ka usoro ịwa ahụ ịchọ mma, ọ bụghị ihe metụtara nsonaazụ bariatric ka ọ rụpụtara, kama ọ bụ ihe kpatara ya. Ọzọkwa, mmetụta a amachaghị mbelata ego nke abụba subcutaneous.

A na - achọpụta data sitere n'ọmụmụ ogologo oge banyere nnukwu njikọta nke ndị ọrịa na - egosi na mgbe ọtụtụ ọrịa metụtara ọrịa, mgbaghara nke T2DM, ya bụ, mmezu nke ọkwa glucose nkịtị na - enweghị ọgwụgwọ shuga na - ebelata, na 76.8% nke ikpe, hyperlipidemia na 83%, yana ọbara mgbali elu na 97%. Dabere na nsonaazụ nke ndị nyocha Sweden, na oge mgbakwunye nke otu ndị ọrịa (puku mmadụ iri) ruo afọ iri na abụọ, ọnụ ọgụgụ ndị nwụrụ mgbe ọgwụgwọ ogwugwo ruru 50% dị ala karịa ndị ọrịa nọ na usoro ọgwụgwọ.

Mmetụta nke ịwa ahụ Bariatric na ọrịa shuga nke 2 na-emetụta ibelata oke ibu

N’ezie, oganihu n’arụ ọrịa shuga na-amaliteworị site n’ụbọchị mbụ mgbe a wasịrị ya ahụ, n’oge gara aga karịa mbelata nke ukwuu n’arụ ahụ. na-ebelata oke ahụ. E nwere ọtụtụ ihe na-emetụta ọrịa shuga.

Thewa ahụ mepụtara ọnọdụ ọhụụ maka mgbanwe dị ukwuu na nri kalori dị ala, na-emegide usoro nke glucose dị n'ọbara na-ebelata ma ọ bụ na-ahazi nke ọma. Na mgbakwunye, n'okpuru ọnọdụ ọhụụ, ahụ na-emepụta homonụ nke ya, nke nwere ọtụtụ uru bara uru.

Ndị amụrụkarị n'ime ha bụ mkpali nke imepụta insulin na-agakọ site na nri nri yana iweghachi mmetụta na mkpụrụ ndụ beta pancreatic. A na - etinye ọgwụ analogues nke ụfọdụ n'ime homonụ ndị a na usoro ugbu a maka ọgwụgwọ nchekwa nke ụdị shuga 2.

Surgerywa ahụ Bariatric bụ ịwa ahụ nwere ọtụtụ nsogbu.

Ọ bụghị naanị ndị ọrịa, kamakwa ndị dọkịta nwere echiche na-enweghị atụ banyere ọtụtụ nsogbu, nke metụtara akụkọ ịwa ahụ maka oke ibu. Eziokwu ahụ bụ na arụmọrụ bariatric mbụ rụrụ karịa ihe karịrị afọ 60 gara aga, na n'ezie, mgbe ọ gasịrị, enwere ọtụtụ nsogbu. Mana site na mgbe arụchara ọrụ mbụ ahụ, arụpụtala ọtụtụ ọrụ dị iche iche ruo taa.

Ọgbọ ọhụụ ọ bụla wepụrụ adịghị ike nke ndị gara aga ma mee ka mmetụta ha dị mma sikwuo ike. Ekwesiri ikwu na ntinye nke teknụzụ laparoscopic nyere aka na mbelata dị ukwuu na ọnụọgụ nsogbu. Ọzọkwa, ndị dọkịta na-awa ahụ na ndị na-akụnwụ ahụ na-ahụ ụzọ ọhụrụ, wepụtara site n'ịwa ahụ ndị ọrịa kansa agadi.

Ihe di nkpa banyere echiche ohuru bu nbido dibia nke onye oria di. Ruo ugbu a, nchekwa nke ịwa ahụ Bariatric tụnyere ọkwa nke nchekwa nke ịwa ahụ trauma mgbe niile.

Atricwa ahụ a na-ahụ anya bụ arụmọrụ akwara na - enweghị ike ịgbanwe akwara ndị “ahụ siri ike”

Ezohie ụzọ ọzọ bụ na ịwa ahụ Bariatric na-eduga na ntụgharị mmebi akwara nke usoro nri. Nke a abụghị eziokwu. Nke mbu, nmekorita aru nke ndi mmadu n’ime ha bu oke ibu ma buru kwa okwu bu mkparita uka, n’ihi na mgbanwe n’ime ogha n’iru ya oge 1.5-2 agagh abu akporo iwu.

Nke abuo, na onodu ndi ahu mgbe achọrọ ịwa ahụ ara ara, ọ bụ arụ nke emebisiela ma ọ bụ tufuo, nke na-enweghị ohere iji gbakee..

Ya mere, ịwa ahụ buru oke ibu, na-eme mgbanwe na anatomi na arụ ọrụ ọfụma, na -emepụta ọnọdụ mmegharị ahụ ọhụụ nke anụ ahụ na-alaghachi na nkịtị, arụ ọrụ physiological.

Nke ahụ bụ, itinye ọgwụ bariatric, dịka ọrụ ịwa ahụ ọ bụla, anaghị arụ ọrụ, mana weghachite ọrụ mbụ furu efu n'ihi mgbanwe mgbanwe arụmọrụ kachasị mma.

Surgerywa ahụ Bariatric bụ ọgwụgwọ dị oke ọnụ

Dika ihe omumu emere na India, obodo nke nwere onodu kacha elu n’uwa n’onwa T2DM, onu ego nke iji onye ori T2DM na enwe nsogbu n’enweghi nsogbu bu ihe ruru $ 650 kwa afo.

Dingtinye otu nsogbu na-abawanye ego site na oge 2.5 - ruo $ 1692, na-agbakwunye nsogbu siri ike karịa ugboro 10 - ruo $ 6940. N’aka nke ọzọ, ịwa arụ na-ebelata ego ịgwọ onye ọrịa ugboro iri - rue $ 65 kwa afọ.

Agaghị enwe ike igosipụta akụkụ akụ na ụba nke mbelata dị ukwuu na nri oriri mgbe a wasịrị ya ahụ, nke bụ otu n'ime isiokwu nke mkparịta ụka siri ike na nzukọ maka ndị ọrịa na-awa ịwa ahụ.

Surgerywa ahụ Bariatric bụ panacea - mgbe ọwachara ahụ, onye ọrịa na-atụfu ibu na-enweghị mgbali ma ga-enwetacha nsonaazụ zuru oke

Enwere echiche ndị na-ezighi ezi n'akụkụ nke ọzọ, jikọtara ya na atụmanya dị elu site na ịwa ahụ bariatric. Ejikọtara echiche a na arụ ọrụ ụgha na arụ ọrụ ga-edozi nsogbu niile nke onye ọrịa ahụ, ọdịnihu ọ dịghị ya mkpa itinye mbọ ọ bụla. Nke a abụghị eziokwu.

Thewa ahụ bụ naanị ọnọdụ mmegharị ahụ e mepụtara ọhụrụ maka mweghachi na nhazi nke ọrụ adịghịzi arụ ọrụ, maka onye ọrịa - mmalite nke ọhụụ na ọ bụghị mgbe niile ụzọ siri ike.

Ọrịa ọ bụla na-eche ime ịwa ahụ ara Bari kwesịrị ịma na taa 10-20% nke ndị ọrịa na-alaghachite oke ahụ ha ogologo oge. Ọtụtụ n'ime ndị ọrịa a bụ ndị na - ahụghị maka onye na - ahụ maka nri nri ma ọ bụ dọkịta na - awa bari.

Onye ọ bụla nke na-eche echiche banyere ịwa ahụ ara ara kwesịrị ịghọta na mgbe a wasịrị ya, ịgbanwe ụdị ndụ ọ bụla, ịgbaso ụkpụrụ iri nri kwesịrị ekwesị na ndụmọdụ nri, na-ahụ ọkwa dị mma nke mmega ahụ, ma, n'ezie, nlekọta ahụike bụ iwu kwesịrị ime.

Ọ bụ onye nchọpụta na-eme nchọpụta na Labolọ Ọrụ Na-ahụ Maka Surgicallọ Ọrụ Nnyocha Nlekọta nke Ọrịa Mmezi, nke dọkịta na-awa na Federal State Budgetary Institution “North-West Medical Institute nke a kpọrọ Acad. V.A. Almazova

Ibepu edemede banyere sayensi na ogwu na ahu ike ohaneze, onye dere akwukwo sayensi - Yershova Ekaterina Vladimirovna, Troshina Ekaterina Anatolyevna

Ojiji nke iji akwara bariatric na ndị ọrịa nwere oke ibu na ụdị ọrịa shuga mellitus 2 (T2DM) nwere atụmatụ nke ya. Na nkuzi a, e gosipụtara ihe na contraindications maka arụmọrụ bariatric, gụnyere akọwapụtara na ọnụnọ T2DM. A kọwara ụdị ọrụ dị iche iche nke Bariatric na usoro nke mmetụta ha na carbohydrate na lipid metabolism. E gosipụtara nsonaazụ mgbochi na-egbochi ịwa ahụ n'ụba n'ime ndị ọrịa nwere oke ibu na ụdị ọrịa shuga 2. A na-ewepụta ihe achọrọ maka arụmọrụ bariatric yana paramm maka ịtụle arụmọrụ ha, gụnyere mgbaghara nke T2DM mgbe mgbochi bariatric gasịrị. A na-enyocha ihe ndị na-akpata hypoglycemia post-bariatric, yana ndị na-ebu amụma banyere prognosis nke ịdị irè nke arụmọrụ bariatric na njikwa metabolic na ndị ọrịa nwere oke ibu na T2DM.

Ojiji nke ime ara bariatric na ndi oria nwere oria nke abuo: inye aka n’oru onye oka

Ojiji nke iji akwara bariatric na ndị ọrịa nwere oke ibu na ụdị ọrịa shuga mellitus 2 (T2DM) nwere atụmatụ nke ya. Na nkuzi a anyị na-atụle ihe ndị na-egosi na contraindications maka ịwa ahụ bariatric, gụnyere akọwapụtara, dịka ọmụmaatụ. ọnụnọ nke ọrịa shuga 2. Typesdị dị iche iche nke ịwa ahụ Bariatric na usoro nke mmetụta ha na glucose na egbugbere ọnụ> ịwa ahụ bariatric na ndị ọrịa nwere oke ibu na ụdị ọrịa shuga 2, anyị na-ewetara chọrọ maka ịwa ahụ Bariatric na usoro nyocha nke arụmọrụ ya, gụnyere mgbaghara ụdị ọrịa shuga 2 mgbe ịwachara bariatric. . Ihe kpatara postpo hypoglycemia, yana ndi buru amụma banyere ịdị irè nke ịwa ahụ bariatric maka njikwa metabolic na ndị ọrịa nwere oke ibu na ụdị shuga 2.

Ederede nke sayensi na isiokwu "Ojiji nke ịwa ahụ maka ọrịa shuga 2: iji nyere onye na-arụ ọrụ aka"

Ibu ibu na metabolism. 2016.13 (1): 50-56 DOI: 10.14341 / OMET2016150-56

Ojiji nke oria bariatric maka udiri oria abuo: iji nyere ndi dibia aka

Ershova E.V. *, Troshina E.A.

Statelọ Ọrụ Federal Steeti Steeti Endocrinological Scientific Center nke Ministry of Health of Russia, Moscow

(Onye isi - Onye Ọkachamara nke RAS I.I. Dedov)

Ojiji nke iji akwara bariatric na ndị ọrịa nwere oke ibu na ụdị ọrịa shuga mellitus 2 (T2DM) nwere atụmatụ nke ya. Na nkuzi a, e gosipụtara ihe na contraindications maka arụmọrụ bariatric, gụnyere akọwapụtara - ọnụnọ nke T2DM. A kọwara ụdị ọrụ dị iche iche nke Bariatric na usoro nke mmetụta ha na carbohydrate na lipid metabolism. E gosipụtara nsonaazụ mgbochi na-egbochi ịwa ahụ n'ụba n'ime ndị ọrịa nwere oke ibu na ụdị ọrịa shuga 2. A na-ewepụta ihe achọrọ maka arụmọrụ bariatric yana paramm maka ịtụle arụmọrụ ha, gụnyere mgbaghara nke T2DM mgbe mgbochi bariatric gasịrị. A na-enyocha ihe ndị na-akpata hypoglycemia post-bariatric, yana ndị na-ebu amụma banyere prognosis nke ịdị irè nke arụmọrụ bariatric na njikwa metabolic na ndị ọrịa nwere oke ibu na T2DM.

Keywords: oke ibu, ụdị shuga mellitus nke 2, ịwa ahụ bariatric

Ojiji nke ịwa ahụ Bariatric na ndị ọrịa nwere ụdị shuga 2: enyemaka nye onye na-eme Ershova E.V. *, Ttoshina E.A.

Ebe nyocha Endocrinology, Dmitriya Ulyanova St., 11, Moscow, Russia, 117036

Ojiji nke iji akwara bariatric na ndị ọrịa nwere oke ibu na ụdị ọrịa shuga mellitus 2 (T2DM) nwere atụmatụ nke ya. Na nkuzi a anyị na-atụle ihe ndị na-egosi na contraindications maka ịwa ahụ bariatric, gụnyere akọwapụtara, dịka ọmụmaatụ. ọnụnọ nke ọrịa shuga 2. Typesdị dị iche iche nke ịwa ahụ na usoro nke mmetụta ha na glucose na metabolism metabolism. Anyị na-egosi nsonaazụ mmachi na ịwapụta bariatric ịwa ahụ na ndị ọrịa nwere oke ibu na ụdị ọrịa shuga 2, anyị na-ewetara ihe achọrọ maka ịwa ahụ bariatric na usoro nke nyocha nke arụmọrụ ya, gụnyere mgbaghara ụdị ọrịa shuga 2 mgbe ịwachara bariatric. Ihe kpatara postpo hypoglycemia, yana ndi buru amụma banyere ịdị irè nke ịwa ahụ bariatric maka njikwa metabolic na ndị ọrịa nwere oke ibu na ụdị shuga 2. Keywords: oke ibu, ụdị shuga 2, ịwa ahụ bariatric.

* Onye ode akwukwo maka nepenucKu / Onye ode akwụkwọ ozi - [email protected] DOI: 10.14341 / 0MET2016150-58

Bariwa ahụ a na-ahụ maka Bariatric (sitere na Greek. Bago - arọ, nke dị arọ) bụ ịwa ahụ a na-eme na ngọngọ nri iji belata ahụ (MT).

N’oge na-adịbeghị anya, ejirila usoro ịwa ahụ mee ihe n’ụwa niile iji gwọọ oke ibu, enwere echiche doro anya ịbawanye ọnụ ọgụgụ nke arụmọrụ a na-eme ma gbasa ọnụ ọgụgụ nke mba ebe ịwa ahụ bariatric na-agbasawanye.

Ebumnuche nke ọgwụgwọ ịwa ahụ nke oke ibu:

♦ n'ihi mbelata dị ukwuu na MT, na-emetụta usoro nke ọrịa na-etolite ka MT na-abawanye (ụdị ọrịa shuga 2), ọbara mgbali elu, ọrịa apnea n'abalị, ọrịa akwara na-arịa ọrịa afọ, wdg.

Mee ka ndu ndi oria buru ibu di nma.

Ihe ngosi maka ogwugwo bariatric

Enwere ike ịme ọgwụgwọ ịgwọ ọrịa oke ibu ma ọ bụrụ na usoro nchekwa ndị a mere na mbụ iji belata MT na ndị ọrịa dị n’agbata afọ 18 ruo 60 adịghị arụ ọrụ na:

Ity oke ibu (body mass index (BMI)> 40 n'arọ / m2),

Ity Ebu oke ibu na BMI> 35 n'arọ / m2 na ọrịa ọnya na-agbanwe agbanwe nke na-enweghị afọ ojuju nke mgbanwe ndụ na ọgwụgwọ ọgwụ. Mkpuchi ịwa ahụ na Bariatric bụ ọnụnọ nke onye a na-eme ntuli aka:

♦ mmanya na-egbu egbu, ọgwụ ọjọọ ma ọ bụ ihe ọ otherụ otherụ ọ bụla ọzọ,

♦ na-egbu mmụọ ọnya afọ ma ọ bụ duodenum,

Mgbanwe ndị a na - agbanwe agbanwe na akụkụ akụkụ ahụ dị oke mkpa (obi na-adịghị ala ala nke usoro ọmụmụ III - IV, imeju ma ọ bụ akụrụ),

♦ghọta ihe egwu dị na arụmọrụ Bariatric,

Enweghi nnabata maka mmejuputa atumatu oge nlere anya nka. Ihe mgbochi pụrụ iche maka imepụta ụdị ịwa ahụ ara na ndị ọrịa bu oke ibu na ọrịa shuga bụ:

Antib ezi ihe mgbochi maka glutamic acid decarboxylase ma ọ bụ sel sel Langerhans,

C-peptide achọtaghị ihe ịchọrọ? Gbalịa ọrụ nhọrọ akwụkwọ.

Arụ ọrụ bariatric niile, dabere na mmetụta ha na anatomi nke eriri afọ, nwere ike kewaa atọ dị iche iche: na-egbochi, na-egbochi (malabsorption) na agwakọta. Nhọrọ nke usoro ịwa ahụ na-adabere n ’oke ibu, nkọwapụta nke nsogbu mgbanwe ọrịa metabolic na ọrịa, njiri mara nke onye ọrịa, ụdị omume iri nri na njikere nke onye ọrịa maka ọgwụgwọ na mgbanwe ndụ. Ọtụtụ mgbe, nhọrọ nke usoro ịwa ahụ na-adabere na ahụmịhe nke dọkịta na-awa ahụ.

Ebidoro igbochi (mgbochi) igbochi afọ ya. N'oge arụmọrụ mgbochi, a na-ekewa afọ n'ime akụkụ abụọ, na-eme ka olu nke akụkụ dị elu ghara ịkarị 15 ml. Enwere ike ime nke a site na ntanetị ukwu nke afọ ya na mwepụ dị warara pụọ ​​na obere akụkụ ya (vetikal gastroplasty (VGP), Fig 1a), ma ọ bụ site na itinye silicone cuff (eriri afọ kwesịrị ekwesị (BZ), fig 1b). Usoro ohuru ohuru - ogologo nke uzo (tubular, vetikal) nke akpiri afo (PRG, Fig. 1c) gunyere mwepu otutu afo n’onu nwere otutu warawara ebe uzo ya di 60-100 ml.

Usoro nke mmetụta metabolic nke ịwa ahụ na-egbochi bariatric ịwa ahụ

Nsonaazụ mmachi arụmọrụ n’ihe gbasara imeziwanye usoro metabolic n’ụdị shuga 2 sitere na:

Na-amanye ndị ọrịa n'oge ọrịa tupu ha abịa nri kalori dị ala,

♦ ma naanị ya na - esote - mbelata nke abụba buru ibu, incl. visceral, dị ka isi iyi nke abụba n'efu na sistem veinal portal n'oge lipolysis, nke na-enyere aka belata nguzogide insulin,

The n'ihe gbasara ọrịa kansa prostate - wepu mpaghara mpaghara mkpụrụ ndụ na-emepụta, nke nwere ike

Mgbachi akpa mgbochi mgbochi

Ahịrị eriri afọ

Pyloric akụkụ nke afọ

Fig. 1. surgerywa ahụ na-egbochi mgbochi: a) vertical gastroplasty, b) bandwid nke afo, ogologo nke afo.

imechi agụụ ma belata agụụ.

A na-eji arụmọrụ ndị na-apụnara mmadụ ihe na-egbochi obere oge na mmekpa ahụ, na-anabata ndị ọrịa, mana n'ọtụtụ oge, ọkachasị oke ibu (ma ọ bụ oke ibu, nke BMI> 50 n'arọ / m2), mmetụta ha enweghị akwụghị chịm. N'ihe banyere ọnwụ nke mmachi ahụ ogologo oge (dịka ọmụmaatụ, na ịcheghari sigetik vetikal, mmetọ nke obere akụkụ afọ ma ọ bụ mmerụ ahụ), enwere ezigbo mgbapụta nke ma nweghachi MT na mkpochapụ DM2.

Ndabere nke ihe ndi malbsorbent (shunting) na arụmọrụ jikọtara ọnụ bụ imechi akụkụ dị iche iche nke obere eriri afọ, nke na-ebelata oriri. N'oge gastroshunting (GSh, Fig. 2a), ọtụtụ n'ime afọ, duodenum na akụkụ mbụ nke obere eriri afọ na-agbanye na nri nri, yana ijeri biliopancreatic (BPS, fig. 2b na 2c), ihe fọrọ nke nta ka ọ bụrụ jejunum dum.

Ejikọtara ọrụ ọnụ, na-ejikọta ihe ndị na-egbochi ma na-akpachi anya, na-egosipụta oke ihe dị ukwuu na ihe ọghọm nke nsonaazụ na-adịghị mma, na-enye nsonaazụ dị ogologo ma kwụsie ike, ma na-emetụta n'ụzọ dị mma nke ọrịa metabolic na ọrịa metụtara oke ibu, nke na-ekpebi ihe ha uru.

Ofzọ usoro nke GSH na metabolism metabolism na oke ibu na ụdị shuga 2:

Na-amanye mgbanwe n'oge izizi ihe dị ka nri nwere obere kalori,

Mwepu nke duodenum site na ịkpọtụrụ na nri nri, nke na-eduga na mgbochi nke ihe ndị dị na diabetogenic, ihe a na-akpọ anti-incretins (ndị ga - ekwe omume bụ glucose na-adabere inspeototropic polypeptide (HIP) na glucagon), ewepụtara na proximal akụkụ nke obere eriri afọ na nzaghachi nnabata n'ime ya nri na ngwaahịa counter ma ọ bụ ihe nke insulin,

Food mee ka nri dị ngwa ngwa n'ime obere eriri afọ, nke na-enye aka na mwepụta glucagon dị ka peptide-1 (GLP-1), nke nwere mmetụta glucose na-emetụta insulinotropic, nke na-atụnye ụtụ n'ihe akpọrọ “incretin mmetụta” nke na-eme mgbe chyme ruru ogoal L-cell ọkwa. eriri afọ (ihe nwere ike itolite na mgbapụta ọgbụgba - ihe ngosipụta kachasị dị egwu na - egosiputa ọrịa ahụ - na - egbochi ohere ndị ọrịa na - a carbohydụ carbohydrates dị mfe ọrịa).

Hib egbochi ihe nzuzo glucagon n'okpuru GLP-1,

Na –eme ka okpukpu osooso gboo n'ihi ihe GLP-1 n’abia n’uche nke ụbụrụ,

♦ jiri nwayọ belata oke abụba visceral.

Fig. 2. Imechi ogwugwo bariatric: a) eriri afọ,

b) HPS site n'aka Hess-Marceau (“Ad hoc afo”) (“Duodenal Switch”) 1. Duodenum. 2. Ihe na-ejikarị eriri afọ. 3. Gall

afụ. 4. Afọ eme nyocha 5. Biliopancreatic loop.

6. Jugoiliac anastomosis. 7. Ndị cecum. 8. Obere eriri afọ.

9. Ogwe. 10. Mkpịsị ụkwụ. 11. cgba mmiri pancreatic.

BPSh n'ime mgbanwe Scopinaro na-apụta ọdịdị dị n'okpuru afọ, na-ahapụ olu olu afọ site na 200 ruo 500 ml, na-agafe obere eriri afọ na anya nke 250 cm site na ụlọocecal, nguzobe nke enteroenteroanastomosis - 50 cm Ogologo nke loop a na-ahụkarị bụ 50 cm, na ihe oriri 200 cm (Fig.2b).

Classicrụ ọrụ BPSH oge ochie na mgbanwe Scopinaro n'otu akụkụ ụfọdụ nke ndị ọrịa sokwa na mmepe nke ọnya ọgbụgba, ọbara ọgbụgba, na ọrịa ọgbụgba. Ya mere, a na - eji ya oge ụfọdụ.

Na HPS, na ngbanwe nke Hess - Marceau (Bilio-pancreatic Diversion na Duodenal Switch, ya bụ, HPS (mgbatị ahụ na duodenum agbanyụrị)), emepụtara pyloric na-egbochi ọrịa prostate, ụlọ ahụ abụghịkwa ọnya afọ nke afọ, mana ọnụnọ nke akpa nke afọ ahụ. . Ogologo eriri afọ nke na-ekere òkè na nri dị ihe dị ka 310-350 cm, nke 80-100 cm ka etinyere na oghere nkịtị, 230-250 cm ka alimentary (Fig 2c). Uru uru nke oru a gụnyere ichebe pylorus na mbelata n'ihi nke a enwere ike ịmalite ọrịa ọgbụgba na peptic

ọnya na mpaghara nke duodenoeleanastomosis, bụ nke a na-emekwa ka ọ bụrụ na ọnụ ọgụgụ dị ukwuu nke mkpụrụ ndụ parietal na-akwadokwa n'oge PRG.

Na mgbakwunye na usoro ndị akọwapụtara maka ịdabere na usoro metabolism na oke ibu na T2DM n'ọnọdụ BPS, enwere:

Mala nhọrọ malabsorption nke abụba na carbohydrates dị mgbagwoju anya n'ihi mbubata mgbakwunye nke bile na pancreatic enzymes n'ime mgbaze, nke na-eme ka mbelata mkpịsị nke abụba n'efu na sistem veinal na, n'ihi ya, na mbelata insulin iguzogide, bụ ihe kachasị mkpa na-ekpebi mmezi nke usoro T2DM,

♦ nhọrọ mbelata nkwonkwo ụrọ ectopic na akwara nke akwara na umeji, nke na-eme ka insulin nwee uche (ebe ọ bụ na imeju oke nwere oke ibu na - eme ka uru mkpụrụ akụ dị na ya) wee na --eme ka uru ya ghara ịba ụba, nke na - edugakwa n’inwe abụba na akwara. , nke mebere ndabere nke dyslipidemia na insulin iguzogide na T2DM). Ahụmahụ nke iji usoro ịwa ahụ bariatric na ọrịa buru ibu yana nkwarụ metabolic na ọrịa mere Buchwald H. na Varco R. na 1978 iji chepụta echiche nke ịwa ahụ "akụkụ nke ịwa ahụ bariatric" dịka njikwa ịwa ahụ nke akụkụ ahụ ma ọ bụ usoro ebumnuche nke ebumnuche na-enweta nsonaazụ ihe omimi nke ahụike ka mma. " N'ọdịnihu, omume dị ogologo oge nke iji ịwa ahụ bariatric na ndị ọrịa na-ebu oke ibu ma soro ya T2DM, ebumnuche nke ebido iji belata MT, gosipụtara ohere dị ukwuu nke ịwa ahụ iji nweta nkwụghachi ụgwọ maka T2DM, nke mepụtara megide mmalite nke oke ibu.

N’oge na-adịbeghị anya, a na-enyocha nkwenye siri ike na ụdị nkọwa gbasara ọrịa shuga 2.

obese. Karịsịa, nkwupụta ahụ na mfu dị ukwuu nke MT bụ ihe na-ekpebi imeziwanye njikwa glycemic na T2DM, bụ nke mepụtara megidere oke ibu mgbe ịwachara bariatric, jụrụ site na eziokwu ahụ bụ na a hụrụ mbelata mkpịsị ọnụ site na izu mbụ mgbe ịwa ahụ gasịrị, i.e. ogologo oge tupu mbelata nke ụlọ ọgwụ na MT. Site na mmụba zuru ebe nile nke ụdị ịwa ahụ na-emetụta bariatric (GSH, BPSH) na omume, ọ bịara pụta na mbelata MT bụ naanị otu, mana ọbụghị naanị ihe na-ekpebi mmezi amụma ahụ na metabolism metabolism na oke ndị mmadụ na-arịa T2DM.

Ọrịa Bariatric

ya na oria di abuo

Ebe ọ bụ na ọgwụgwọ nke T2DM gụnyere njikwa nke ọ bụghị naanị njikwa glycemic, kamakwa ihe ndị nwere ike ibute ọrịa obi, a pụrụ ịkwado ịwa ahụ bariatric maka ndị ọrịa nwere oke ibu na T2DM ndị na-emezughị ebumnuche ọgwụgwọ na ọgwụgwọ ọgwụ. ha na - eme ka ọ dị oke mma ọbara ọgbụgba, ọrịa dyslipidemia, nsogbu ihi ụra ụra, wdg, na mgbakwunye, ha belata ọnụ ọgụgụ mmadụ na - anwụ.

Arụ ọrụ mgbochi na-enye aka na nkwụghachi ụgwọ nke T2DM: mmụba nke metabolism metabolism n'ime izu mbụ mgbe ịwa ahụ bụ n'ihi ịnyefe ndị ọrịa na nri kalori na-adịghị ala ala, ma emesịa, ka akụ dasịrị abụba na-ebelata, nkwụghachi ụgwọ nke T2DM ga-ekwe omume, mana ogo ya bụ nke kwekọrọ na ọnụego MT na-efu, na iche na arụmọrụ shunt. mgbe nke a gasịrị gbasara usoro glycemia gosipụtara onwe ya ọbụna tupu mbelata nke MT n'ihi ihe a na-akpọ "mmetụta ọhụụ.

Na nyocha nke meta ya, Buchwald H. et al. weputara nsonaazụ nyocha niile edepụtara banyere ịwa ahụ ara site na 1990 ruo 2006. Ofdị arụmọrụ ha na metabolism metabolism na ndị ọrịa nwere oke ibu

Mmetụta dị iche iche nke ịwa ahụ Bariatric na ọnwụ MT na usoro ọgwụgwọ nke T2DM Isiokwu 1

Onye na-egosi ọnụọgụ BZ VGP GSH BPSH

% ọnwụ MT 55.9 46.2 55.5 59.7 63.6

% nke ndị ọrịa nwere ịkewa ọgwụ gbasara ụlọ nyocha na nyocha ụlọ nyocha na T2DM 78.1 47.9 71 83.7 98.9

Isiokwu 2 ọmụmụ gosipụtara njikwa glycemic ogologo oge mgbe ọwachara bariatric na ndị ọrịa nwere oke ibu na T2DM

Ndị ọrịa, oge nlere, ọnwa. Nsonaazụ

Herbst S. et al., 1984 23 20 AHbA, c = - 3,9%

Ugbo ala W. et al., 1992 52 12 AHbA, c = - 4.4%

Ugboroko W. et al., 1995 146 168 91% b-x nwere normoglycemia 91% b-x ya na HbA1c nkịtị.

Sugerman H. et al., 2003 137 24 83% b-s nwere normoglycemia 83% b-s na HbA1c nkịtị.

Scopinaro N. et al., 2008 312 120 97% ejiri ya na HbA1c nkịtị

Scheen A. et al., 1998 1998 28 28 AHbA1c = - 2.7%

Pontiroli A. et al., 2002 19 36 AHbA1c = - 2.4%

Sjostsrom L. et al., 2004 82 24 72% b-x nwere normoglycemia

Ponce J. et al., 2004 53 24 80% b-x nwere normoglycemia AHbA1c = - 1.7%

Dixon J. et al., 2008 30 24 AHbA1c = - 1.8%

nke ahughi m ihe ichoro? Gbalịa ọrụ nhọrọ akwụkwọ.

na DM2 enyocha site nha ndị ọrịa nwere normalization ma ọ bụ mmelite na ngosipụta nke ụlọ ọgwụ na ụlọ nyocha nke DM2 (ọmụmụ 621 metụtara ndị ọrịa 135,246 gụnyere na meta-analysis) (Tebụlụ 1, 2).

Aghotaara usoro nke onyonye onodu ogwu na ulo nyocha nke T2DM dika ihe nchoputa nke oria nke T2DM na ichoro ị takingubata ogwu okpomoku, imezu oria glycemia i bu achoghi ihe ichoro? Gbalịa ọrụ nhọrọ akwụkwọ.

Monitoring nleba anya na ndị ọrịa na-arụ ọrụ ogologo oge: dị ka sistemụ European SOE - ọ dịkarịa ala afọ ise 75 nke ndị ọrịa ka aga-agbaso,

♦ usoro nyocha njikwa: opekata mpe 1 n'ime ọnwa atọ n'ime afọ 1st mgbe arụ ọrụ ahụ gasịrị, opekata mpe otu oge n’ime ọnwa isii n’ime afọ nke abụọ gachara, mgbe ahụ - kwa afọ,

♦ n'ime ndị ọrịa nwere T2DM, iji belata ihe ize ndụ nke hypoglycemia, iji ọgwụ a na-ebelata shuga ma ọ bụ insulin kwesịrị ịgbanwe n’oge mbido ọrụ.

Nyochaa banyere ịdị irè nke ịwa ahụ bariatric na ndị ọrịa nwere oke ibu na T2DM

International Diabetes Federation (IDF) ewepụtala ebumnuche ndị a:

Ọnwụ nke MT kariri 15% nke mbụ,

Nweta ọkwa HbA1c enweghị ike ịchọta ihe ịchọrọ? Gbalịa ọrụ nhọrọ akwụkwọ.

Inweta ogo LDL-C enwetaghị m ihe ịchọrọ? Gbalịa ọrụ nhọrọ akwụkwọ.

Okwu ikpe nke mmepe nke hypoglycemic steeti akọwara akwụkwọ mgbe akwụkwọ akụkọ gachara nke mpaghara ịwa ahụ na-eme ka ụfọdụ kpachara anya n'oge nlekọta nke ndị ọrịa na oge ọmụmụ.

Enwere ụzọ dị iche iche enwere ike ịdabere na mmepe nke steeti hypoglycemic mgbe ịwa ahụ bariatric gbara gburugburu:

1) ọnụnọ nke b-cell hypertrophy na hyperplasia, bụ nke mere tupu arụ ọrụ ahụ wee bụrụ ihe na-akwụ ụgwọ iji merie nguzogide insulin, na mgbe ịwa ahụ bariatric, ka nguzogide insulin jiri nwayọọ nwayọọ belata, ha nyere aka na ọnọdụ hypoglycemic,

2) Nsonaazụ nke GLP-1 (ọkwa nke na-abawanye nke ukwuu mgbe ọ kwụsịrị ọrụ bariatric) na mmụba nke mkpụrụ ndụ b na mbelata apoptosis ha,

3) nsonaazụ nke ISU (usoro nke mmetụta apụbeghị doo anya),

4) mmetụta nke ghrelin (nke ọkwa ya na-agbadata nke ukwuu ma ewepu ya na mbuba nke afọ), visfatin, leptin, YY peptide (na-eme ka mmetụta ahụ dịkwuo elu) na homonụ ndị ọzọ.

A na-ahụ ugboro ugboro hypoglycemia mgbe ọrụ GSH gasịrị (na 0.2% nke ndị ọrịa na-arụ ọrụ), nke a na-ejikọta ya na ntinye ngwa ngwa site na nri nri nke akụkụ dị warara nke obere eriri afọ, ebe mkpụrụ ndụ L-na-emepụta GLP-1 dị nke ka ukwuu, n'adịghị ka BPS, nke A ga-ewepụ mgbiri afọ niile na mgbaze. Agbanyeghị, data gbasara mkpụrụ ndụ ihe ga - apụta hypoglycemia nke na - apụta dị ugbu a na - emegide onwe ha, a na - achọkwa ọmụmụ ihe ndị ọzọ iji nyochaa usoro ndị a dị n'elu na ụzọ ndị ọzọ enwere ike isi na mmepe ha.

Nsogbu nd ị banyere nka na ọnụego ọnwụ

Ohere inweta nsogbu mbụ (n’ime ụbọchị 30 mgbe a wasịrị ya ahụ) mgbe ụdị usoro sistem dị iche iche anaghị agafe 5-10%.

Onu ogugu onwa banyere uzo oria bariatric di obere, no na 0.1-1.1% ma tunyere otu ihe ngosi maka oru ihe ojoo di ka, dika imaatu, laparoscopic cholecystectomy. Ihe fọrọ nke nta ka ọ bụrụ 75% nke ọnwụ na mmalite oge ọrụ na-emetụta mmepe nke peritonitis n'ihi ịhapụ ọdịnaya nke anastomosis n'ime oghere dị n'ime na 25% bụ nsonaazụ na-egbu egbu metụtara metụtara akwara umeji.

Dika nyocha onu ogugu, onu ogugu onwa n’iru izizi bu 0.28%, karie mgbe, mgbe oghasịrị laparoscopic nke afo ogaghi aga 0.1%, GS - 0.3-0.5%, after BPS - 0.1-0 , 3%. Nkezi onwu na-abawanye site na ụbọchị nke iri atọ ruo n'afọ nke abụọ mgbe a wasịrị ya ahụ 0.35%. N'ime ndị ọrịa ihe karịrị afọ 60, ọnwụ dị elu, ọkachasị na ọnụnọ ọnya na-arịa ọrịa obi. Na mkpokọta, e jiri ya tụnyere ọgwụgwọ na-egbochi oke ibu, ịwa ahụ ara Bari na-ebelata ọnụ ọgụgụ ndị ọrịa na - arụ ọrụ ogologo oge.

Ọ dị mkpa icheta na ọnụego onwu dị ala mgbe ọgwụgwọ ọgwụgwọ oke ibu gụnyere n'ime ndị ọrịa nwere T2DM, enwere ike ịme naanị naanị mgbe ihe niile achọrọ maka ịwa ahụ bariatric na-agbasochi anya na-eburu n'uche njirimara na contraindications, yana nkwadebe nke ọma.

Ndị na-ebu amụma banyere prognosis nke prognosis nke mmelite akwụ ụgwọ maka carbohydrate na metabolism metabolism na ndị ọrịa nwere oke ibu na ụdị shuga 2.

Echere na ihe ndị a kọwara n'okpuru nwere ike ịka njọ prognosis maka mgbaghara nke T2DM nwere ike ịwa ahụ Bariatric:

Ogologo oge nke T2DM,

Level HbA1c dị elu,

Enweghị hyperinsulinemia na insulin na-eguzogide,

Ulin ịba insulin maka ọrịa shuga.

Ihe kpatara nke a bu n ’eziokwu bu na ndi oria nwere oria nke abuo, onu ogugu nke sel-agbadata ka oge na-aga n’ihi onodu ojoo n’etiti apoptosis na neogenesis, ike nke β-sel imegwara maka nnabata insulin na-ebute mmepe nke udiri oria abuo nke mbelata, ya na ikwu ma obu zuru oke insulinopenia. Ya mere, enwere ike iche na n'ọdịdị ndị ọrịa dị n'elu, a na-ekpebi prognosis maka ị nweta ụgwọ maka metabolism metabolism site na ogo nke ap-aposis nke b-sel, yana ihe ndị na-egosi njiri ike nke mkpụrụ ndụ b-sel (ọkwa nke mbu na mkpali C-peptide).

Na mkpokọta, data sitere na akwụkwọ na-egosi na, na ntinye uche nke ndị na-achọ ịwa ahụ maka ịwa bariatric n'ụzọ kwekọrọ na ngosipụta anakwere na contraindications, oge ọrịa ahụ ruru afọ 10-15, na mbụ nchịkwa nchịkwa na-enweghị afọ ojuju, afọ 50, na BMI mbụ adịghị emetụta ya. na prognosis nke imeziwanye usoro metabolic na ndị ọrịa nwere oke ibu na T2DM mgbe ọwachara bariatric, ma ọ bụrụhaala na arụ ọrụ insulin na-arụpụta nke b-sel n’echebe. d dị ka ọkwa mbụ si gbaa ume nke C-peptide.

Atụmanya maka ọmụmụ ihe maka arụmọrụ yana nchekwa nke ọrụ bariatric, nke IDF gosipụtara

Na omumu ihe omimi nke ozo nke akwara nke oria Bariatric di iche-iche na uzo nke T2DM n’ebe ndi oria di oke ibu, odi nkpa:

♦ mkpebi siri ike nke ebumnuche amamịghe maka ịkọ amụma arụmọrụ ọria bariatric ka ya na carbohydrate, lipid, purine na ụdị metabolism ndị ọzọ,

♦ na-eduzi ọmụmụ iji chọpụta ịdị irè nke ịwa ahụ bariatric na ndị ọrịa nwere ụdị shuga 2 na oke ibu nwere BMI na-erughị 35 n'arọ / m2,

♦ na-ekpebi nsonaazụ akwara nke Bariatric na igbochi ma ọ bụ jiri nwayọ kwụsị ọrụ insulin na-arụpụta nke b-sel, njiri mara nke T2DM

Na nyocha nke nsonaazụ ịwa ahụ Bariatric na nsogbu microvascular T2DM,

Trials ọnwụnwa emere ka atụnyere mmetụta dị iche iche nke ịwa ahụ na Bariatric na T2DM.

DOI: 10.14341 / OMET2016150-56

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Ershova Ekaterina Vladimirovna nyocha nke Ngalaba Na-ahụ Maka Ọgwụ na Obesity Group

Mmemme Mmefu ego nke Federal State “Endocrinological Scientific Center” nke Ministri Ahụike Russia E-mail: [email protected] Troshina Ekaterina Anatolyevna MD, prọfesọ, onye isi nke ngalaba ahụike na ndị otu buru ibu.

Statelọ Ọrụ Ego Federal Federal Steeti “Endocrinological Scientific Center” nke Ministri Ahụike Russia

Ojiji nke oria bariatric maka udiri oria abuo: iji nyere ndi dibia aka

Ojiji nke iji akwara bariatric na ndị ọrịa nwere oke ibu na ụdị ọrịa shuga mellitus 2 (T2DM) nwere atụmatụ nke ya. Na nkuzi a, e gosipụtara ihe na contraindications maka arụmọrụ bariatric, gụnyere akọwapụtara - ọnụnọ nke T2DM. A kọwara ụdị ọrụ dị iche iche nke Bariatric na usoro nke mmetụta ha na carbohydrate na lipid metabolism. E gosipụtara nsonaazụ mgbochi na-egbochi ịwa ahụ n'ụba n'ime ndị ọrịa nwere oke ibu na ụdị ọrịa shuga 2. A na-ewepụta ihe achọrọ maka arụmọrụ bariatric yana paramm maka ịtụle arụmọrụ ha, gụnyere mgbaghara nke T2DM mgbe mgbochi bariatric gasịrị. A na-enyocha ihe ndị na-akpata hypoglycemia post-bariatric, yana ndị na-ebu amụma banyere prognosis nke ịdị irè nke arụmọrụ bariatric na njikwa metabolic na ndị ọrịa nwere oke ibu na T2DM.

Kwuru

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Isi okwu

Surgerywa ahụ Bariatric (sitere na Greek baros - siri ike, dị arọ, bụ arọ) bụ ịwa ahụ a na-eme na ngọngọ iji belata oke ahụ (MT).

N’oge na-adịbeghị anya, ejirila usoro ịwa ahụ mee ihe n’ụwa niile iji gwọọ oke ibu, enwere echiche doro anya ịbawanye ọnụ ọgụgụ nke arụmọrụ a na-eme ma gbasa ọnụ ọgụgụ nke mba ebe ịwa ahụ bariatric na-agbasawanye.

Ebumnuche nke ọgwụgwọ ịwa ahụ nke oke ibu:

• n'ihi mbelata dị ukwuu na MT, na-emetụta usoro nke ọrịa ndị na-etolite ka MT na-abawanye (ụdị ọrịa shuga 2) (ọrịa shuga 2), ọbara mgbali elu, ọrịa apnea n'abalị, ọrịa akwara na-arịa ọrịa afọ, wdg.
• melite ogo ndu ndu ndi oria buru ibu.

Ihe ngosi maka ogwugwo bariatric

Enwere ike ịme ọgwụgwọ ịgwọ ọrịa oke ibu ma ọ bụrụ na usoro nchekwa ndị a mere na mbụ iji belata MT na ndị ọrịa dị n’agbata afọ 18 ruo 60 adịghị arụ ọrụ na:

• Ibu oke ibu (body mass index (BMI) ≥40 kg / m2),
• oke ibu na BMI ≥35 kg / m2 yana oria ojoo a na-aru aru nke adighi agbanwe agbanwe site na mgbanwe ndu.

Ntinye ihe mgbochi maka ịwa ahụ bariatric bụ ọnụnọ nke onye chọrọ:

• mmanya, ọgwụ ọjọọ ma ọ bụ ihe ọ bụla ọzọ riri ahụ,
• isi mgbaka
• ọnya iwe nke afọ nke afọ ma ọ bụ duodenum,
• tụụrụ ime
• oncological ọrịa
• mgbanwe ndị a na - atụgharịghị agbanwe na akụkụ nke akụkụ dị oke mkpa (obi anaghị ala ala nke III - IV function klas, hepatic or real ọdịda),
• nghota ihe egwu di iche iche di n’ime oruru bari bari,
• enweghi nnabata maka mmejuputa atumatu nhazi oru nlere anya.

Pụrụ iche contraindications mgbe ị na-eme atụmatụ ịwa ahụ Bariatric na ndị ọrịa nwere oke ibu na ọrịa shuga bụ:

• ọrịa shuga
• Ihe mgbochi dị mma maka glutamic acid decarboxylase ma ọ bụ sel sel Langerhans,
• C-peptide 50 n'arọ / m2), mmetụta ha anaghị akwụ ụgwọ. N'ihe banyere ọnwụ nke mmachi ahụ ogologo oge (dịka ọmụmaatụ, na ịcheghari sigetik vetikal, mmetọ nke obere akụkụ afọ ma ọ bụ mmerụ ahụ), enwere ezigbo mgbapụta nke ma nweghachi MT na mkpochapụ DM2.

Ndabere nke ihe ndi malbsorbent (shunting) na arụmọrụ jikọtara ọnụ bụ imechi akụkụ dị iche iche nke obere eriri afọ, nke na-ebelata oriri. N'oge gastroshunting (GSh, Fig. 2a), ọtụtụ n'ime afọ, duodenum na akụkụ mbụ nke obere eriri afọ na-agbanye na nri nri, yana ijeri biliopancreatic (BPS, fig. 2b na 2c), ihe fọrọ nke nta ka ọ bụrụ jejunum dum.

Ejikọtara ọrụ ọnụ, na-ejikọta ihe ndị na-egbochi ma na-akpachi anya, na-egosipụta oke ihe dị ukwuu na ihe ọghọm nke nsonaazụ na-adịghị mma, na-enye nsonaazụ dị ogologo ma kwụsie ike, ma na-emetụta n'ụzọ dị mma nke ọrịa metabolic na ọrịa metụtara oke ibu, nke na-ekpebi ihe ha uru.

Ofzọ usoro nke GSH na metabolism metabolism na oke ibu na ụdị shuga 2:

• mbughari tupu oge eruo na nri kalori,
• mwepu nke duodenum site na ịkpọtụrụ na nri nri, nke na-eduga na mgbochi nke ihe ndị na-arịa ọrịa shuga, ihe a na-akpọ anti-incretins (ndị ga - ekwe omume bụ glucose na-adabere inspelatotropic polypeptide (HIP) na glucagon), nke ewepụtara na proximal akụkụ nke obere eriri afọ na nzaghachi na ntinye nke nri na ngwaahịa na-emegide ma ọ bụ insulin emereme
• Nweta nri ngwa ngwa banye n'ime akụkụ nke obere eriri afọ, nke na-enye aka na mwepụta nke glucagon dịka peptide-1 (GLP-1), nke nwere mmetụta glucose na-emetụta insulinotropic, nke na-atụnye ụtụ a na-akpọ “mmetụta dị adị” nke na - apụta mgbe chyme ruru ogoum L-sel nke mbụ (ihe gbasara ya mmepe nke ọgbụgba ọgbụgba - nke kacha pụta ìhè ngosipụta akparamaagwa nke ihe a ga - eme na - egbochi ohere ndị ọrịa na - a carbohydụ carbohydrates dị mfe).
• ihe mgbochi nke glucagon zoro ezo n'okpuru nduzi nke GLP-1,
• ngwangwa ngụgụ n'ihi nsonaazụ GLP-1 na mpaghara ụbụrụ kwekọrọ
• nwayọọ nwayọọ na visceral abụba uka.

BPSh n'ime mgbanwe Scopinaro na-egosi ọdịdị dị n'okpuru afọ, na-ahapụ olu olu afọ site na 200 ruo 500 ml, na-agafe obere eriri afọ na anya nke 250 cm site na ụlọocecal, nguzobe nke enteroenteroanastomosis - 50 cm Ogologo nke loop a na-ahụkarị bụ 50 cm, na ihe oriri 200 cm (Fig.2b).

Classicrụ ọrụ BPSH oge ochie na mgbanwe Scopinaro n'otu akụkụ ụfọdụ nke ndị ọrịa sokwa na mmepe nke ọnya ọgbụgba, ọbara ọgbụgba, na ọrịa ọgbụgba. Ya mere, a na - eji ya oge ụfọdụ.

Na HPS na Hess - mgbanwe Marceau (“Nchịkọta Biliopancreatic na Duodenal Switch”, ya bụ, HPS (mgbatị ahụ na duodenum agbanyụrịrị)), a na-eme pyloric na-echekwa ọrịa prostate, ụlọ ahụ anaghị ejikọkwa ọnya afọ, mana ụlọ ahụ ejikọtaghị aka na afọ nke afọ, mana na akụkụ mbụ nke duodenum. Ogologo eriri afọ nke na-ekere òkè na nri dị ihe dị ka 310-350 cm, nke a na-ekenye 80-100 cm ka akaghị aka, 230-250 cm ka alimentary (Fig 2c). Uru dị na ọrụ a gụnyere ichebe pylorus na mbelata n'ihi nke a enwere ike ịmalite nsogbu ọgbụgba na ọnya nkwonkwo na mpaghara duodenoelanastomosis, bụ nke a na-akwadokwa site na mbelata dị ukwuu na ọnụ ọgụgụ mkpụrụ ndụ parietal n'oge ọrịa cancer.

Na mgbakwunye na usoro ndị akọwapụtara maka ịdabere na usoro metabolism na oke ibu na T2DM n'ọnọdụ BPS, enwere:

• nhọrọ abụba nke abụba na carbohydrates dị mgbagwoju anya n'ihi mbubata mgbakwunye nke bile na pancreatic enzymes n'ime mgbaze, nke na-eme ka mbelata mkpokọta abụba n'efu na sistem veinal na, n'ihi ya, na mbelata insulin iguzogide, bụ ihe kachasị mkpa na-ekpebi mmezi nke usoro T2DM,
• Mbelata ụtụ ectopic lipid n'ọkpụkpụ akwara na akwara, nke na-eme ka insulin mara mma (ebe ọ bụ na imeju oke site na lipids na-ejikọ ya na oke adịghị ike nke adipose anụ ahụ iji kpoo egbugbere ọnụ ma nwekwuo olu ya, nke na-eduga n'inwe ụtụ ectopic nke abụba na lipotoxicity, na-eke ihe ndabere nke dyslipidemia na insulin iguzogide na T2DM).

Ahụmahụ nke iji usoro ịwa ahụ bariatric na ndị ọrịa buru ibu yana nkwarụ metabolic na ọrịa na-ekwe ka Buchwald H. na Varco R. na 1978 guzopụta echiche nke ịwa ahụ "akụkụ nke ịwa ahụ bariatric" dị ka njikwa ịwa ahụ nke akụkụ ahụ ma ọ bụ usoro iji mezuo ndu. nsonaazụ ahụike ahụike. ”N’ọdịnihu, omume dị ogologo oge nke iji ịwa ahụ ara Bari na ndị ọrịa na-ebu oke ibu ma soro ya T2DM, ebumnuche nke ebidobelata MT, gosipụtara ohere dị ukwuu nke ịwa ahụ iji nweta ụgwọ maka T2DM, mepụtara megide oke nke oke ibu.

N'oge na-adịbeghị anya, enyochaala nkwenye siri ike na ụdị akụkọ metụtara T2DM na ndị ọrịa buru ibu. Karịsịa, nkwupụta ahụ na mfu dị ukwuu nke MT bụ ihe na-ekpebi imeziwanye njikwa glycemic na T2DM, bụ nke mepụtara megidere oke ibu mgbe ịwachara bariatric, jụrụ site na eziokwu ahụ bụ na a hụrụ mbelata mkpịsị ọnụ site na izu mbụ mgbe ịwa ahụ gasịrị, i.e. ogologo oge tupu mbelata nke ụlọ ọgwụ na MT. Site na mmụba zuru ebe nile nke ụdị ịwa ahụ na-emetụta bariatric (GSH, BPSH) na omume, ọ bịara pụta na mbelata MT bụ naanị otu, mana ọbụghị naanị ihe na-ekpebi mmezi amụma ahụ na metabolism metabolism na oke ndị mmadụ na-arịa T2DM.

Ofdị irè nke ịwa ahụ bariatric maka ụdị shuga 2

Ebe ọ bụ na ọgwụgwọ nke T2DM gụnyere njikwa nke ọ bụghị naanị njikwa glycemic, kamakwa ihe ndị nwere ike ibute ọrịa obi, a pụrụ ịkwado ịwa ahụ bariatric maka ndị ọrịa nwere oke ibu na T2DM ndị na-emezughị ebumnuche ọgwụgwọ na ọgwụgwọ ọgwụ. ha na - eme ka ọ dị oke mma ọbara ọgbụgba, ọrịa dyslipidemia, nsogbu ihi ụra ụra, wdg, na mgbakwunye, ha belata ọnụ ọgụgụ mmadụ na - anwụ.

Arụ ọrụ mgbochi na-enye aka na nkwụghachi ụgwọ nke T2DM: mmụba nke metabolism metabolism na izu mbụ mgbe ịwachara ahụ bụ n'ihi nbugharị nke ndị ọrịa na nri calorie dị ala, ma emesịa, ka akụ dasịrị abụba na-ebelata, nkwụghachi ụgwọ nke T2DM ga-ekwe omume, mana ogo ya bụ nke kwekọrọ na ọnụego MT na-efu, na iche na arụmọrụ shunt. mgbe nke a mechara gbasara glycemia gosipụtara onwe ya ọbụna tupu mbelata nke MT n'ihi ihe a na-akpọ "nsonaazụ ahụ."

Na nyocha nke meta ya, Buchwald H. et al. weputara nsonaazụ nyocha niile edepụtara banyere ịwa ahụ ara site na 1990 ruo 2006. A na-enyocha ike nke mmetụta ha na metabolism metabolism na ndị ọrịa nwere oke ibu na T2DM site na nha nke ndị ọrịa nwere ezipụ ma ọ bụ mmelite nke ngosipụta ụlọ ọgwụ na ụlọ nyocha nke T2DM (ọmụmụ 621 metụtara 135,246 ndị ọrịa gụnyere usoro nyocha-meta) (Tebụlụ 1, 2).

Tebụl 1. Mmetụta dị iche iche nke ịwa ahụ ara Bari na ọnwụ MT na ụlọọgwụ nke T2DM