手术治疗型糖尿病.ppt

胆胰绕道手术 十二指肠转位 312 patients BMI 50.1 32.0 at 10 years. Diabetes resolution 98%. 亚洲的经验 (胃缩小手术) 胆胰绕道手术 5 patients BMI 30.9 (27-33) One year later, BMI 25.4 at 10 years. Hba1C from 8.5 to 5.6 新的手术- Ileal interposition 19 patients BMI 40.2 Weight loss 38.4% 5 DM patients resolution 新的手术- Duodenaljejunal Bypass DJB 12 patients Age 49.8; BMI 25.6 HbA1c 8.9%, duration 9y At 6m, BMI 24.2, HbA1C 7.8% Better than control G 新的手术- Duodenaljejunal Bypass DJB 新的方法- Duodenal-jejunal bypass sleeve 12 patients for 12 weeks. HbA1C 0.5% 糖尿病的自然病史 * * * * * * * * * * 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 BMI 35 1.85% BMI 30-35 8.58% BMI 27-30 16.87% 2555 cases 影响糖尿病人手术效果的原因 Older people A longer history of T2DM Severe disease, high dose of insulin usage Poorly control DM may accelerates B-cell failure Bariatric 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 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 BMI＜35 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 预测糖尿病手术效果的指针 胃束带与糖尿病 60 0bese patients ( BMI 30 and 40 ) with recently diagnosed ( 2 years) type 2 diabetes Randomized to two arms Remission of T2DM was 73% in the surgical group and 13% in the conventional-therapy group Weight 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 缩胃与糖尿病 30 patients with DM( BMI 35; mean 46 ) Retrospective review with 6 months follow-up All patients had improvement Remission of T2DM was 87.5% for those had DM 5 years but was only 35.7% for who had DM 5 years Rosenthal R et al. SOARD 2009;5:429-