Zaka zingapo zapitazi, tapindula ndi zochitika zomwe sitinayambepopo pomvetsetsa za matenda a shuga , kuyang'anira , kasamalidwe , ndi chithandizo . Kupita patsogolo uku kumaphatikizapo kumvetsetsa bwino za microvascular ndi macrovascular mavuto a matendawa - "microvascular" amatanthauza mitsempha yaing'ono yamagazi ndi "macrovascular" amatanthauza mitsempha yambiri ya magazi, monga yomwe imapezeka mu mtima ndi ubongo-komanso mosalekeza (" wochenjera ") kuyang'anira glucose ngakhale kagulu katsopano ka shuga: sodium-glucose cotransporter 2 (SGLT2) inhibitors monga Invokana.
Komabe, kupita patsogolo konseku kumatanthauza pang'ono kwa anthu ambiri omwe ali ndi shuga. Ngakhale kuti mankhwalawa ndi othandizira bwino, osachepera 50 peresenti ya anthu omwe ali ndi matenda a shuga a mtundu wa 2 amakhala ndi shuga wokwanira wa magazi ndipo akhoza kukhala pachiopsezo cha matenda a shuga, ndipo 80 peresenti ya anthu omwe ali ndi matenda a shuga amakhala ndi mavuto a mtima.
Kuyambira chakumapeto kwa zaka za m'ma 1980, ochita kafukufuku ndi madokotala anazindikira kuti anthu ambiri omwe amadwala kwambiri matenda a shuga, kapena anthu odwala matenda a shuga, amene amalandira chithandizo chamagetsi, kapena opaleshoni, amawongolera kusintha kwa chiwindi komanso kuchepa kwa mtima. Komanso, anthu ena amene amalandira opaleshoni yamagetsi amamva kukhululukidwa kwapadera ndipo safunikiranso kumwa mankhwala alionse! Ngakhale zili choncho, akatswiri akhala akukayikira kuti adzivomereze pothandizira zachipatala zokhudzana ndi malo omwe opaleshoni amachiza matenda a shuga a mtundu wachiwiri ... kufikira kufikira kumapeto kwa msonkhano wa opaleshoni wa shuga (DSS-II) mu September 2015 .
Zolemba, ngakhale kuti nthawi zambiri zimagwiritsidwa ntchito mosiyana, opaleshoni ya bereatric imangotanthauza opaleshoni yolemetsa, pamene opaleshoni yamagetsi imatanthawuza opaleshoni yopititsa patsogolo matenda a shuga ndi matenda opatsirana.
Pa DSS-II, akatswiri ochokera padziko lonse lapansi amagwirizana ndi magulu 45 akutsogolera azachipatala, kuphatikizapo magulu asanu ndi limodzi omwe akutsogolera matenda a shuga: American Diabetes Association, International Diabetes Federation, Chinese Diabetes Society, European Association for Study of Diabetes Shuga India, ndi Matenda a shuga ku UK, adakambirananso umboni wonse womwe ulipo ndikupanga malingaliro othandizira kusintha padziko lonse pokhudzana ndi chithandizo cha opaleshoni ndi zachipatala pochiza matenda a shuga.
Anaperekanso chitsogozo chofunika kwambiri pokhudzana ndi chisankho cha opaleshoni komanso opatsirana otsogolera otsogolera.
Mitundu Yopaleshoni Zamagetsi
Kuchita opaleshoni ya kulemera kwa thupi kunalandira makina ochuluka kwambiri kwa zaka zambiri. Momwemonso muli ndi lingaliro la zomwe zina mwa njirazi zikuphatikizapo. Komabe, tiyeni tichite mwamsanga kubwezeretsa mitundu ikuluikulu ya opaleshoni yamagetsi.
- Roux-en-Y chapamimba chimadutsa . Ndondomekoyi ndiyo njira yowonjezera ya bariatric yomwe ikuchitika padziko lonse lapansi. Kuchita opaleshoniyi kumachitidwa mwachisawawa, kapena mwa njira zochepa zowonongeka, ndipo zimayambitsa kulemera kwakukulu ndi kusintha kwa shuga. Roux-en-Y zimadutsa m'mimba ndipo zimaphatikizapo kupanga chikwama cha m'mimba kuchokera kumimba ndikugwiritsira ntchito chikwama chaching'ono m'mimba mwachindunji. Izi zimapangitsa kuti chifuwa chachikulu ndi m'matumbo chikhale chachikulu. Zotsatira zake zimangowonjezera m'mimba. malo apamwamba ndipo amachititsa kuti munthu asamamve bwino, kapena kuti amve bwino, komanso amachepetsanso kuchepetsa mafuta. Zindikirani, njira zowonjezera zomwe zimasintha kukula kwa mmimba zimatchedwanso zoletsa; koma, zomwe zimatulutsa m'mimba ndi kusintha mafinya amatchedwa malabsorptive. Anthu oposa 75 peresenti ya anthu omwe ali ndi matenda a shuga omwe amalowa mu roux-en-Y m'mimba mwadongosolo amatha kudzalandira chikhululukiro. Kuwonjezera pamenepo, oposa 90 peresenti ya odwalawa adzalandira chitukuko m'mabungwe ena a matenda opatsirana, kuphatikizapo kuchepa kwa mankhwala a lipid (cholesterol ndi triglyceride). Pofuna opaleshoniyi, anthu omwe amapeza opaleshoniyi amalephera kuthetsa kupweteka pakati pamtima, kupanikizika, mavuto osabereka, kusautsika maganizo, kudzidalira komanso khalidwe labwino.
- Mapulogalamu apamwamba a laparoscopic : Njirayi yatsopano imakhala yotchuka kwambiri ku United States. Panthawiyi, madokotala ochita opaleshoni amachotsa pakati pa 75 ndi 80 peresenti ya m'mimba pamene amasiya matumbo ena onse. Poyamba, akatswiri amaganiza kuti njira iyi inali chabe yokakamiza; Komabe, kafukufuku waposachedwapa amasonyeza kuti njirayi imapangitsanso kumasulidwa kwa incretins kapena mahomoni omwe amachititsa kuti kutulutsa insulini kumatulutse. Ngakhale kufufuza kwina kuyenera kuchitidwa kufufuza phindu la kugonana kwa manja, zikuwoneka kuti kugwiritsira ntchito manja kumakhala kofanana ndi roux-en-Y chapamimba choyendetsa poyerekezera ndi kulemera kwa thupi ndi kuchepa kwa kagayidwe ka shuga, omwe ali ndi matenda ofanana ndi matenda a shuga ndi kuchepa kwa matenda a shuga ndi zifukwa zoopsa.
- Mapuloteni osinthika a laparoscopic : Njira yothandizira m'mimba ya mimba imaphatikizapo kuika gulu kumbali yakumtunda kuti apange thumba laling'ono lomwe limapangitsa kuti asamapangidwe. Chifukwa chifuwa chachikulu cha gastric band chimavuta kwambiri kusiyana ndi mitundu ina ya opaleshoni ya opaleshoni ya opaleshoni ndi Roux-en-Y - zimatenga nthawi yaitali kuti zisawonongeke ndi kusintha kwa shuga. Komabe, pakati pa 50 ndi 80 peresenti ya anthu omwe akulandira njirayi chikhululukiro cha shuga. Kuwonjezera apo, anthu omwe amapeza njirayi amacheperanso m'magulu a lipid, ngakhale pang'ono poyerekeza ndi kuchepa kwawoneka pambuyo pa mitundu ina ya opaleshoni yamagetsi.
- Biliopancreatic diversion ndi kusintha kwa duodenal (BPD / DS) : Popanda kukhala ndi nitty-gritty, chonde kumbukirani kuti, monga momwe zingatchulidwe ndi dzina lake, BPD / DS ndi njira yovuta yomwe imaphatikizapo kukonzanso matumbo. Kuchita opaleshoniyi ndi kovuta komanso kosavuta komanso kumagwiritsidwa ntchito kwa anthu apamwamba kwambiri (aganize BMI oposa 50). Chofunika kwambiri, BPD / DS chimakhala ndi machitidwe akuluakulu komanso otetezeka kwambiri owonetsetsa kulemera pakati pa zochitika zonse za opaleshoni zamagetsi ndi kukula kwakukulu kwa matenda a shuga ndi mafilimu. Ndipotu, kafukufuku wina wasonyeza kuti pafupifupi 100 peresenti ya anthu omwe amapeza njira imeneyi amachiza matenda a shuga! Komanso, BPD / DS ndi yovomerezeka kwambiri chifukwa chothandizira kwambiri kugona kwa mpata pakati pa odwala omwe akulandira. Komabe chifukwa cha chikhalidwe chake chachikulu-kukonzanso ndikukhadzula matumbo kumabweretsa mavuto aakulu-anthu omwe amalandira njirayi ali ndi chiopsezo chowonjezeka cha kuchepa kwa zakudya, zina zomwe zimamveka bwino ndipo zingakhale zoopsa.
Mu 2013, opaleshoni ya 179,000 yolemera kwambiri inachitika. Pano pali kusweka:
- 42 peresenti anali kapangidwe kake ka manja
- 34 peresenti anali ndi chapamimba chopitirira
- 14 peresenti anali chapamimba lap band
- 1 peresenti anali BPD / DS
- 6 peresenti adasinthidwa
Zoopsa
Zonsezi, opaleshoni yamagetsi ndi yotetezeka, makamaka ngati imachitidwa ndi dokotala wodziwa bwino wodwala wodwalayo amene wakonzekera njirayi ndipo wapereka njira yopambanayo. Komabe, monga opaleshoni yonse, zinthu zoipa zimachitika pambuyo pakuchitidwa opaleshoni. Motero, opaleshoni yamagetsi imakalipidwa ngati mankhwala a mzere wachiwiri ndikusungidwa kwa anthu omwe amalephera kuchipatala pogwiritsa ntchito zakudya, masewera olimbitsa thupi, ndi mankhwala.
Nazi zotsatira zina zovuta zokhudzana ndi opaleshoni yamagetsi. Chonde dziwani kuti zotsatira zovuta izi zimasiyanasiyana malinga ndi ndondomeko yomwe yapangidwa. Mwachitsanzo, Roux-en-Y ndi BPD / DS ndizovuta kwambiri ndipo zingabweretse mavuto ambiri; pamene, chapamimba cha band-band amagwiritsa ntchito zotsatira zochepa zomwe sizikugwirizana ndi matumbo enieni.
- Zofooka zamagetsi ndi zakudya
- Zilonda
- Gastric remnant distension kumatsogolera ku ileus (kutsekera m'mimba)
- Cholelithiasis (gallstones)
- Hernia pa malo a incision
- Adhesions (malo osungira omwe amamatira ndi kulepheretsa matumbo)
- Matenda otaya
- Kulephera kwa impso
- Kutenga
- Stenosis
- Kutha kwa Band (ndi lap band)
- Sinthani zizolowezi zamagazi
- Reflux
Mndandanda uwu sungakhale wamphumphu kapena womveka ku mtundu wina uliwonse wa opaleshoni yamagetsi. Chonde funsani zotsatira zowopsa za opaleshoni musanayambe kuchita zimenezi. Kuonjezeraninso, kambiranani izi mwachindunji mwatsatanetsatane ndi dokotala wanu ndi gulu la zaumoyo. Kuchita opaleshoni yamagetsi sizowonongeka komwe kudzachiza matenda anu onse popanda zotsatira. M'malo mwake, ndi chisankho choyenera kuti musinthe thanzi lanu.
Kodi Ndi Odwala Otani Amene Ali ndi Matenda Otawopsa Ambiri Amene Ali Odwala Opaleshoni?
Monga tanenera kale, kwa nthawi yoyamba akatswiri a DSS-II analimbikitsa njira yothandizira odwala matenda a shuga pogwiritsa ntchito opaleshoni. Chofunika kwambiri, akatswiri amavomereza kuti opaleshoni imalingaliridwa mwa anthu omwe ali ochepa kwambiri (BMI pakati pa 30 ndi 34.9) omwe ali ndi shuga yomwe siiliyendetsedwa ndi mankhwala am'kamwa kapena insulini.
Nazi malangizidwe othandizira odwala matenda a shuga:
- Opaleshoni yamagetsi ayenera kuyanjidwa kwa odwala omwe ali ndi sukulu III kunenepa kwambiri (BMI oposa 40) omwe sakhala olamuliridwa mwa kusintha kwa moyo (chakudya ndi masewero olimbitsa thupi) komanso chithandizo chamankhwala (kumwa mankhwala ndi insulini).
- Mofananamo, opaleshoni yamagetsi ayenera kulangizidwa kwa odwala omwe ali ndi chiwerengero cha kunenepa kwachiwiri (BMI pakati pa 35 ndi 35.9) omwe amakhalabe osayendetsedwa ngakhale kuti akusintha moyo wawo.
- Monga tafotokozera pamwambapa, opaleshoni yamagetsi iyenera kuganiziridwa ndi anthu omwe ali ochepa kwambiri (BMI pakati pa 30 ndi 34.9) ndipo sangathe kulamulira matenda awo a shuga ngakhale kusintha kwa zakudya komanso masewero olimbitsa thupi komanso chithandizo chamankhwala ndi mankhwala a pakamwa ndi insulini.
Akatswiri amalimbikitsanso kuti zigawozi ndi zochepetsedwa zisinthe kwa anthu a ku Asia. Tiyenera kukumbukira kuti ngakhale zizindikiro zothandizira matenda a shuga pogwiritsa ntchito opaleshoni komanso kuchuluka kwa kulemera kwa anthu a mafuko osiyanasiyana zingakhale zosiyana, kusintha kwakukulu kwa shuga ndi madyerero othetsera opaleshoni amatha kufanana pakati pa mafuko onse. Mwa kuyankhula kwina, opaleshoni mofananamo imapindulitsa anthu a mafuko onse pokhudzana ndi kusintha kwa shuga ndi kukhululukidwa kwa matenda.
Zina mwazifukwa, chifukwa mtundu wa shuga 2 sungatengedwenso kukhala "wachikulire" ndipo umakhudza chiwerengero chowonjezereka ndi chowopsya cha ana ndi achinyamata, akatswiri akulangiza kuti kafukufuku wopitilira akuchitidwa kuti athetse ntchito yokhudza opaleshoni yamagetsi pochiza ana ndi shuga. Komanso, akatswiri amalimbikitsanso kufufuza kwina kuti ngati opaleshoni ingathandize anthu odwala matenda a shuga kwambiri. Mwachindunji, mwa anthu omwe ali ndi matenda a shuga a mtundu wa 1, opaleshoni ya bereatric ingathandize kutsogolera bwino magazi ndi kuchepetsa kufunika kwa insulini komanso kuchepa kwa matenda a mtima.
Kodi Opaleshoni Yophatikizapo Mankhwala Amachita Motani?
Njira zomwe opaleshoni zamagetsi kapena zachipatala zimachiza shuga ndi zovuta komanso zosagwirizana. Zoonadi, kusintha kapena kukhululukidwa kwa matenda a shuga chifukwa cha opaleshoni yotereyi kumakhudza zambiri ndi kuchepetsa kalori ndi kuchepa kwa thupi. Komabe, pali zifukwa zina zambiri zomwe zimathandiza kuchiza matenda a shuga kuphatikizapo zotsatirazi:
- Kusintha kwa bile acid metabolism
- GI thirakiti yowona ndikugwiritsa ntchito shuga
- Kuchokera kwa Incretin (kumbukirani kuti anthu omwe amachititsa kuti insulin imulandire mpweya wabwino)
- Ntchito yotsutsa-incretins
- Kusintha kwa zomera zam'mimba (kupanga mabakiteriya omwe amakhala m'matumbo)
Zowonjezereka, zotsatirazi ndi zina zomwe sitinayambe kuziyanjanitsa zomwe zimayambitsa matenda a shuga ndi kukhululukidwa pambuyo pa opaleshoni. Komanso, zina mwa njirazi zimadalira mtundu wa opaleshoni yomwe ikuchitidwa.
Mawu Ochokera
Ngati inu kapena wokondedwa wanu ali ndi matenda a shuga omwe sagonjetsedwa ndi zakudya, masewera olimbitsa thupi, ndi mankhwala, mungafune kukambirana ubwino wa opaleshoni yamagetsi ndi dokotala wanu. Ngakhale kuti opaleshoni yotereyi sichikuchira mankhwala oyamba, opaleshoni yotereyi ingakuthandizeni kupewa matenda a shuga ndi kuvutika.
Chifukwa chakuti miyeso yachilendo ndi yachilendo ingayambe kusamalitsa matenda anu a shuga, izo sizikutanthauza kuti mkhalidwe wanu ulibe chiyembekezo kapena moyo wanu sudzakhala bwino. Chonde kumbukirani kuti opaleshoni yamagetsi ndi njira yotetezeka yambiri yomwe ili ndi madalitso ambiri kuphatikizapo chithandizo cha mtundu wa shuga. Komanso, onani kuti opaleshoni yamagetsi ndi njira yomwe imafuna kukonzekera, kulingalira, kukhudzidwa, ndi kudzipereka zambiri. Kuchita opaleshoni sikumangokhala kosavuta kapena kosavuta ndipo kumafuna kupanga moyo wodzipereka wathanzi komanso kupanga chisankho chodziwika bwino.
Ngati muli ndi mafunso okhudzana ndi matenda a shuga kapena opaleshoni yolemala, pangani mgwirizano ndi dokotala wanu kuti mukambirane za mavuto anu ndi zosankha zanu.
Zotsatira:
Batterham RL ndi Cummings DE. Njira Zowonjezera Katemera wa shuga Kutsata Bariatric / Opaleshoni Yamakono. Chisamaliro cha Shuga 2016 Jun; 39 (6): 861-877.
Cefalu WT, Rubino F ndi Cummings DE. Opaleshoni Yophatikiza Mankhwala a Mtundu wa Shuga Wachiwiri: Kusintha Malo Omwe Amasamalira Matenda a Shuga. Chisamaliro cha Shuga 2016 Jun; 39 (6): 857-860.
Ellsmere JC, Jones D ndi Chen W. Zidzakhala zovuta za opaleshoni yopangira opaleshoni. Kupita ku 2016.
Rubino F, Nathan DM, Eckel RH, et al. Kuchita Opaleshoni Zamagetsi mu Chithandizo Chachidule cha mtundu wa shuga wa mtundu wa 2: Chigwirizano Chogwirizana cha International Diabetes Organizations. Chisamaliro cha Shuga 2016 Jun; 39 (6): 861-877.
Schauer PR, Schirmer B. The Management Management of Obesity. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Mfundo za Schwartz za Opaleshoni, 10e . New York, NY: Hill ya McGraw; 2014.