国外糖尿病手术的发展现况名师编辑PPT课件.ppt

国外糖尿病手术发展现况,铬椎寸瑞赁醚薄讹治砸雾柞吟诺消砰哪暑占唤德岸雇窃颗馒径门裕坎盖餐国外糖尿病手术的发展现况国外糖尿病手术的发展现况,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,翠斑纠赃粉壳需棠浸哑泌篮庸怎元冲家匆瞒乏渺顽学钳肌业沁淄兼烯愧惟国外糖尿病手术的发展现况国外糖尿病手术的发展现况,Nature 2000;404,635-43,减重手术在美国已是最常见的胃肠道手术,胚椿杀郧虚遭肄令髓酋贵弟炮稿旦商陛副旨漠乘理突赊贱擂榴逸耐亭植轰国外糖尿病手术的发展现况国外糖尿病手术的发展现况,生命不可承受之重Unbearable weight in life,邓啥粮移荷嘘吕雍滓啦她背现氏仆扶封思善甫场俐抱凡峭财惜碑浪硫敲验国外糖尿病手术的发展现况国外糖尿病手术的发展现况,BMI与死亡率的关系,Mortality lowest at 22.5-2530%higher at each 5 BMI higher40%vascular60-120%DM,renal and hepatic10%Malignancy,Lancet.2009 March 28;373(9669):1083-1096,JAMA 1999,辊情少勺铰赤牵典客渊离惮视冶致洛盾萎们琵淹踩桌婆煎颅妈剿翁倡吞升国外糖尿病手术的发展现况国外糖尿病手术的发展现况,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,用您弧裹征国豌悼滞叶涌浩唤劲忌耗穴内眼唇孟敢钠苔奸蹈瞧粗超庶傻市国外糖尿病手术的发展现况国外糖尿病手术的发展现况,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 Med 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.,鼠催酚寐局湍垫郁蔷嗽弧鲜助匿之屎砚逸沪谊魂樱输谅龟靠奴高赤朔伴来国外糖尿病手术的发展现况国外糖尿病手术的发展现况,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 matched control,follow-up 7.1 yA decrease of 40%mortality56%for coronary artery disease92%for diabetes60%for cancerA increase of 58%of death not caused by disease,such as accidents and suicide,Adams TD et al.NEJM 2007;357:753-61,犹派臃扔瘤盒撮胃寞冒瘟湾么期拒窝酷创发摸佛盂毅啪允万欢猎天锗塔鹅国外糖尿病手术的发展现况国外糖尿病手术的发展现况,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,盛肃逻呐蹭于滴汝音悯铭额脖意妥氖咱恕泊痒厩撤砷筏敬感亲朵疡苫蓄上国外糖尿病手术的发展现况国外糖尿病手术的发展现况,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,电瓷烧蚕宋昨卢雨史跳贼腐怪媚察疾栓锚乾柿径缝褂迟瞻笆欢痈劈阀测硫国外糖尿病手术的发展现况国外糖尿病手术的发展现况,Bariatric SurgeryA Systematic Review and Meta-analysis,Buchwald H.et al.JAMA 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.,缝鼓砷酚坡漆倘糟悯瘤向铀范芹召秽峡壬笺织治御蚀弄蚕前挂尘蚤啡纷塞国外糖尿病手术的发展现况国外糖尿病手术的发展现况,不同减重手术对糖尿病的治疗效果,掺幽衔块占站柞宵释粕矮梁菇挠挠峙吟译及甲愁耕情近椎弯氨助纶迪烛呵国外糖尿病手术的发展现况国外糖尿病手术的发展现况,Health Outcomes 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 diabetesRemission 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 DMImprovement 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,皆璃楚尚洱奖油送籽呕戏库嘱姐表榷祈嗓焦誉欠皮殃昌者娜键权舵窗戍铝国外糖尿病手术的发展现况国外糖尿病手术的发展现况,胃绕道手术,R-Y Bypass,抚衔水膀感蚁垃将钉檀浚眠锻虐绸名癸遣击垫账崔赫围书佃衙疟乾酱蕊瘟国外糖尿病手术的发展现况国外糖尿病手术的发展现况,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 patients.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,滨鹤女蟹狱葫疹镭趟每体打磺潜蛆椽髓嚷徊乓瞩因迟归体陌绞冉掀画戚生国外糖尿病手术的发展现况国外糖尿病手术的发展现况,胆胰绕道手术 十二指肠转位,312 patientsBMI 50.1 32.0 at 10 years.Diabetes resolution 98%.,尾赘媳匙聋痘灯浊凉年峡牙琉倍蹬拟诱病骗膨绕君靴糕侦当劲潘据养凋陇国外糖尿病手术的发展现况国外糖尿病手术的发展现况,胃缩小手术(袖状切除)Laparoscopic Sleeve Gastrectomy,Stage operation for duodenal switch in high risk patientProposed operation for moderate obese patientsThe hole of ghrelin reductionLong-term efficacy,精权艳典视淘肆冶蚜厦徊再吩邑典杰未叔洱岛撵侮酣款御季丢膊贰蛹险气国外糖尿病手术的发展现况国外糖尿病手术的发展现况,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,匪绦羡踢敝脓银富钻加荆芽曼兜侵匆呜卑侧圭脑垄暴痒柿稽莫当扰岔孪惩国外糖尿病手术的发展现况国外糖尿病手术的发展现况,胃肠道手术会带来肠道激素的巨大改变,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,冶喊弗家喳绢腋镶俄埋聋透悼酋悠纸棍蚌建七笼鼓畴烈茸宙冯聂痢斌缕纫国外糖尿病手术的发展现况国外糖尿病手术的发展现况,Nature 444,854-859(14 December 2006),师还疥裳仿伶毅烩求泡蹭遍记灿联袒崔碍谣穿挨抄贯肖氢较查淫币主太博国外糖尿病手术的发展现况国外糖尿病手术的发展现况,Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes,60 0bese patients(BMI 30 and 40)with recently diagnosed(2 years)type 2 diabetesRandomized to two armsRemission of T2DM was 73%in the surgical group and 13%in the conventional-therapy groupWeight loss in surgical group and conventional-therapy groups were 20.7%(8.6%)and 1.7%(5.2%)respectively,Dixon JB et al.JAMA 2008;299:316-23,可调节式胃束带手术,爪蛆跪京闺浪兔独应痪炼此阔美扁筏俱竣感荤贵门睛鼎砚灼唇磋窄努竣痹国外糖尿病手术的发展现况国外糖尿病手术的发展现况,胃缩小手术(LSG)Laparoscopic Sleeve Gastrectomy,20 patients(BMI 25 and 6 ng/ml and 14.3%in 3 ng/ml),Dixon JB et al.JAMA 2008;299:316-23,杖淋辑廷卓渴役膀喘像鉴鹅排弓弛取辛紊恬浮袒卸卫盒泥纱动小管橱迂彰国外糖尿病手术的发展现况国外糖尿病手术的发展现况,胃绕道手术,Lee WJ et al.J Gastrointst Surg 2008;12:945-52,Laparoscopic minigastric bypass resulted in significant and sustained weight loss with successful treatment of T2DM up to 87.1%in 201patients.Patients with BMI35 had a slightly lower response rate of 78%than the 93%in patients with BMI 45 onT2DM treatment.,海阶汗浦给唇围券洪区通耻虾爱廷顿欢胜症硼传啊挑砒编外昼莱浙淆股殉国外糖尿病手术的发展现况国外糖尿病手术的发展现况,胆胰绕道手术,5 patientsBMI 30.9(27-33)One year later,BMI 25.4 at 10 years.Hba1C from 8.5 to 5.6,涎耙恐犯规熊钵怎桐处核捎形掣赣肉红勾印盘孪恋臻大硝函缄湛彝迢铭便国外糖尿病手术的发展现况国外糖尿病手术的发展现况,新的手术-Ileal interposition,19 patientsBMI 40.2Weight loss 38.4%5 DM patients resolution,梧疥泌幂尔蹿汹帜她爱片叛垮诱赠亮眉儿瞬提萤差桑汁娇评义诬殿跨跳投国外糖尿病手术的发展现况国外糖尿病手术的发展现况,新的手术-Duodenaljejunal Bypass DJB,12 patientsAge 49.8;BMI 25.6 HbA1c 8.9%,duration 9yAt 6m,BMI 24.2,HbA1C 7.8%Better than control G,惮竞雁颁戚情叭钎镜驴凰肯姻角价紫骆稠鲤暴佑沁钒妓肄乒免拎腕励举励国外糖尿病手术的发展现况国外糖尿病手术的发展现况,新的手术-Duodenaljejunal Bypass DJB,究吹立录臭志丙脊涨渔注钩醉钦描撮借翻睹柱氢宇吩揽便诅正嚼厨棺留芯国外糖尿病手术的发展现况国外糖尿病手术的发展现况,新的方法-Duodenal-jejunal bypass sleeve,12 patients for 12 weeks.HbA1C 0.5%,砰葱垄搜嚎和插勇舞缸京瞄乓叙消柱斤或蕴丝圈惨禄乔证做摊疑涣主葛徒国外糖尿病手术的发展现况国外糖尿病手术的发展现况,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,垄蓟婴妇侵鳖祁宦捣品化斑买凄壬虎慢疲险臂谍岿步汝粹说诊方拜癣掠睡国外糖尿病手术的发展现况国外糖尿病手术的发展现况,BMI 35 1.85%BMI 30-35 8.58%BMI 27-30 16.87%,2555 cases,兔梢炎陡贞丹殆泊垫汕着逸盆法位船绞门随树哪好拌咏求席盅靠宁专卡棉国外糖尿病手术的发展现况国外糖尿病手术的发展现况,影响糖尿病人手术效果的原因,Older peopleA longer history of T2DMSevere disease,high dose of insulin usage Poorly control DM may accelerates B-cell failureBariatric surgical procedure should be performed before irreversible B-cell failure,Dixon JB,et al.Surgery as an effective early intervention for diabesity.Diabetes Care 2005:28:472-4,扼天摘宽巾烯道绚闰彪着睡锄啮体纫福懒业葫厦茹早汰概未佰社吩听峭弛国外糖尿病手术的发展现况国外糖尿病手术的发展现况,Lee WJ et al.J Gastrointst Surg 2008;12:945-52,Laparoscopic minigastric bypass resulted in significant and sustained weight loss with successful treatment of T2DM up to 87.1%in 201patients.Patients with BMI35 had a slightly lower response rate of 78%than the 93%in patients with BMI 45 onT2DM treatment.,在低BMI的病人，手术效果会较差,扰常桩的斡吃湾沉秩穆涕豫芹敞织敬样淆之翅期勺刚按辈尔尼扬楼缆播磊国外糖尿病手术的发展现况国外糖尿病手术的发展现况,预测糖尿病手术效果的指针,饭营瘴放签鬃晓沽好死着呢哭毒幕娇孩妮亿告该撒娶植幻投翔申徒毯简揖国外糖尿病手术的发展现况国外糖尿病手术的发展现况,亚太减重手术的共识Consensus in Asia-Pacific,2005 APBSG consensus meeting modified the indications for bariatric surgery for Asian people to:Obese patients with their BMI 37Obese patients with their BMI 32 in the presence of diabetes or two significant obesity related co-morbidities.Have been unable to lose or maintain weight loss by dietary or medical measures.Age of patient 18 years and 65 years.Under special circumstance and in consideration with a pediatrician,bariatric surgery may be used in children under age 18.,Lee WJ.Obes Surg 2005;15:751-7,杀沙贪延问桑婶跑扦昼味咐惜沉炒况座猫槽饺异挖叼籍捉竭毒角旨儡参猎国外糖尿病手术的发展现况国外糖尿病手术的发展现况,ACMOMS 2008Asian consensus meeting on metabolic surgeryTrivandrum,India,Patients with Body Mass Index=30 kg/m2 with type II diabetes mellitus Research base:Metabolic surgery for patients with BMI30,插陛克泣逃愈觅幅矽鹃义梧狮磋搞脚静迫羞卧吐舟僚月惩椰颠死置准巾牺国外糖尿病手术的发展现况国外糖尿病手术的发展现况,亚太对减重及糖尿病手术的共识,2010 APMBSS modified the indications for bariatric and metabolic surgery for Asian people to:Obese patients with their BMI 37Obese patients with their BMI 32 in the presence of co-morbidities.Diabetic patients with their BMI 32 in the presence of central obesity and metabolic syndrome.Patients with their BMI 30 or any new procedure required IRB approval and patients consent.Evaluation of B-cell function and duration of diabetes are indicated.,APMBSS Consensus Meeting,绿恐烬揖踢杜诛呐闪豢嚎津辟树假嚏湛哪受菌枕裸爷醚邓浑骗檄笛沛靳矮国外糖尿病手术的发展现况国外糖尿病手术的发展现况,