国外糖尿病手术的发展现况.ppt
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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-intestinal Metabolic surgery) 病人的选择,Nature 2000; 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 Unbearable weight in life,BMI与死亡率的关系,Mortality lowest at 22.5-25 30% higher at each 5 BMI higher 40% vascular 60-120% DM, renal and hepatic 10% Malignancy,Lan
2、cet. 2009 March 28; 373(9669):1083-1096,JAMA 1999,减重手术是严重肥胖最有效的治疗方法 Effect of Bariatric Surgery on Mortality in Swedish Obese Subjects,Lars Sjostrom et al. N Engl J Med 2007:357:741-52,减重手术对瑞典病人死亡率的影响 Effect of Bariatric Surgery on Mortality in Swedish Obese Subjects,Lars Sjostrom et al. N Engl J Me
3、d 2007:357:741-52,Unadjusted overall mortality was reduced by 24.6%(p=0.0346) Adjusted risk reduction was 31.6%(p=0.00083) Mortality difference was mainly attributable to reductions in coronary events and cancers.,胃绕道手术对长期死亡率的影响 Long-term mortality after gastric bypass surgery,7925 surgical vs. 7925
4、 matched control, follow-up 7.1 y A decrease of 40% mortality 56% for coronary artery disease 92% for diabetes 60% for cancer A increase of 58% of death not caused by disease, such as accidents and suicide,Adams TD et al. NEJM 2007;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-intestinal Metabol
5、ic surgery) 病人的选择,Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus,Pories WJ, Swanson MS, MacDonald KG, et al. Ann Surg 1995;222:339-350,在肥胖病人,减重手术可长期根治糖尿病,Bariatric Surgery A Systematic Review and Meta-analysis,Buchwald H. et al. JAMA
6、 2004:292:1724-1737,Conclusion effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of with Diabetes, Hyperlipidemia,Hypertension and Obstructive sleep apnea experienced complete resolution or improvement.,不同减重手术对糖尿病的治疗效果,Health Out
7、comes of Severely Obese Type 2 Diabetic Subjects 1 Year After Laparoscopic Adjustable Gastric Banding,50 0bese patients ( BMI 48.2 + 8 Kg/M2 ) with type 2 diabetes Remission of T2DM was 64% and HbA1c decreased 1.6 (from 7.8 to 6.2) Remission of diabetes predicted by weight loss % and duration of DM
8、Improvement of DM associated with increased insulin resistance and B-cell function,Dixon JB et al. Diabetes Care 2002;25:358-63,可调节式胃束带手术,胃绕道手术,R-Y Bypass,Lee WJ et al. Obesity surgery resulted in significant and sustained weight loss with a cure rate of T2DM up to 80% in morbidly obese Asian patien
9、ts. Gastric bypass surgery had a better result in T2DM cure rate than LVBG and LAGB because of better weight reduction.,World Journal of Surgery 2009;33:1895-1903,Effects of Obesity Surgery on Type 2 Diabetes Mellitus Asian Patients,胆胰绕道手术 十二指肠转位,312 patients BMI 50.1 32.0 at 10 years. Diabetes reso
10、lution 98%.,胃缩小手术 (袖状切除) Laparoscopic Sleeve Gastrectomy,Stage operation for duodenal switch in high risk patient Proposed operation for moderate obese patients The hole of ghrelin reduction Long-term efficacy,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-intestinal Metabolic surgery) 病人的选择,胃肠道手术会带来肠道激素的巨大
11、改变,By altering the guts production of hormones, gastric bypass surgery may be able to eliminate type 2 diabetes. But scientists worry that this radical operation can also cause dangerously low blood sugar.,25 APRIL 2008 VOL 320 SCIENCE,Nature 444, 854-859 (14 December 2006),Adjustable Gastric Bandin
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