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1.
Since February 1, 1980, the identical standardized Greenville Gastric Bypass has been performed in 397 morbidly obese patients with an operative mortality rate of 0.8%. The operation effectively controlled weight and maintained satisfactory weight loss even after 6 years (mean weights and ranges: Preoperative: 290 lbs (196-535); 18 months: 175 lbs (110-300); 72 months: 205 lbs (140-320). The gastric bypass favorably affected non-insulin-dependent diabetes (NIDDM), hypertension, physical and role functioning, and several measures of mental health. Rigorous follow-up (97.5% over 6 years) revealed that health problems were common in postoperative patients; there were nine late deaths. Abnormal glucose metabolism was present in 141 (36%) of 397 patients before surgery: NIDDM was present in 88 patients (22%) and 53 patients (14%) were glucose impaired. Of these, all but two became euglycemic within 4 months after surgery without any diabetic medication or special diets. The most recent 42 morbidly obese patients with NIDDM were studied intensively. In that cohort, fasting blood glucose, fasting insulin, and glycosylated hemoglobin returned to normal after surgery; insulin release, insulin resistance, and utilization of glucose improved sharply. The normalization of glucose metabolism after gastric bypass may not be related solely to weight loss and restriction of caloric intake, but may also be due to the bypass of the antrum and duodenum.  相似文献   

2.

Background

Gastric bypass has profound effects on glycemic control in adults with type 2 diabetes mellitus. The goal of this study was to examine the long-term rates and clinical predictors of diabetes remission and relapse among patients undergoing gastric bypass.

Methods

We conducted a retrospective cohort study of adults with uncontrolled or medication-controlled type 2 diabetes who underwent gastric bypass from 1995 to 2008 in three integrated health care delivery systems in the USA. Remission and relapse events were defined by diabetes medication use and clinical laboratory measures of glycemic control. We identified 4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass.

Results

Overall, 68.2 % (95 % confidence interval [CI], 66 and 70 %) experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % (95 % CI, 32 and 38 %) redeveloped diabetes within 5 years. The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration. Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (p?=?0.03).

Conclusions

Gastric bypass surgery is associated with durable remission of type 2 diabetes in many but not all severely obese diabetic adults, and about one third experience a relapse within 5 years of initial remission. More research is needed to understand the mechanisms of diabetes relapse, the optimal timing of surgery in effecting a durable remission, and the relationship between remission duration and incident microvascular and macrovascular events.  相似文献   

3.
胃转流手术治疗2型糖尿病的可行性   总被引:3,自引:1,他引:2  
目的对病态肥胖症手术对2型糖尿病的影响及其作用机制做一综述, 同时探讨病态肥胖症手术是否也可用于治疗不伴有肥胖症的2型糖尿病病人. 背景资料全世界有超过1.5亿人罹患2型糖尿病,虽然对高血糖的严格控制使得2型糖尿病并发症的发生率大大减少,但目前的治疗方法还不能达到根治.某些用于治疗病态肥胖症的手术不仅导致显著而持久的体重下降,而且使2型糖尿病得以缓解. 方法复习文献,回顾分析肥胖症手术对继发的糖代谢和内分泌变化的影响. 结果胃转流和胆胰转流术后数天内,80%~100%严重肥胖的糖尿病病人血糖、血胰岛素和糖化血红蛋白达正常水平,胃肠道激素分泌形式发生显著变化.病例报道也证实因其它因素施行胆胰转流的非病态肥胖患者避免罹患2型糖尿病.结论胃转流和胆胰转流术似乎对控制2型糖尿病有原发的、独立的影响,而不是继发于对肥胖症的治疗.虽然还需要对不伴肥胖患者进行对照研究,但胃转流手术的确有可能改变当前对2型糖尿病病理生理的理解,甚至改变该病的治疗方法.  相似文献   

4.
BACKGROUND: Obesity is known to be a major risk factor for cardiovascular diseases. There are few studies in the literature assessing the effect of bariatric procedures on longterm risk of cardiovascular events. The aim of this study was to determine the effect of gastric bypass operation on actual and Framingham risk of coronary heart disease (CHD) events in class II to III obesity. STUDY DESIGN: In a cohort of subjects with class II to III obesity, we used the observed change in CHD risk factors and risk models derived from the Framingham data equation to calculate the predicted 10-year absolute and relative risk of CHD after gastric bypass operation. The risk predicted by the Framingham model was then compared with the actual incidence of CHD events of the cohort. RESULTS: Five-hundred patients were included in the study. The 1-year mean excess body weight loss was 68.7% +/- 22%. There was a substantial reduction in prevalence of diabetes from 28% to 6% (p = 0.001). Compared with baseline, the average 10-year absolute risk of cardiac events decreased from 5.4% at baseline to 2.7% at 1 year after operation (p = 0.001). A similar risk reduction was observed in subgroups defined by diabetes status and gender. Gastric bypass decreased absolute risk of cardiac events by a mean of 63% (p = 0.0001) in diabetics and 56% (p = 0.001) in male patients. The cohort actual rate of CHD events was 1% (5 of 500). At the 5-year horizon, this was considerably (p = 0.001) lower than the predicted rate before gastric bypass operation. CONCLUSIONS: Gastric bypass operation is effective in reducing actual and the 10-year Framingham risk of CHD events in individuals with class II to III obesity. The major estimated risk reduction was observed in male patients with type 2 diabetes.  相似文献   

5.
Potential of surgery for curing type 2 diabetes mellitus   总被引:29,自引:0,他引:29  
Rubino F  Gagner M 《Annals of surgery》2002,236(5):554-559
OBJECTIVE: To review the effect of morbid obesity surgery on type 2 diabetes mellitus, and to analyze data that might explain the mechanisms of action of these surgeries and that could answer the question of whether surgery for morbid obesity can represent a cure for type 2 diabetes in nonobese patients as well. SUMMARY BACKGROUND DATA: Diabetes mellitus type 2 affects more than 150 million people worldwide. Although the incidence of complications of type 2 diabetes can be reduced with tight control of hyperglycemia, current therapies do not achieve a cure. Some operations for morbid obesity not only induce significant and lasting weight loss but also lead to improvements in or resolution of comorbid disease states, especially type 2 diabetes. METHODS: The authors reviewed data from the literature to address what is known about the effect of surgery for obesity on glucose metabolism and the endocrine changes that follow this surgery. RESULTS: Series with long-term follow-up show that gastric bypass and biliopancreatic diversion achieve durable normal levels of plasma glucose, plasma insulin, and glycosylated hemoglobin in 80% to 100% of severely obese diabetic patients, usually within days after surgery. Available data show a significant change in the pattern of secretion of gastrointestinal hormones. Case reports have also documented remission of type 2 diabetes in nonmorbidly obese individuals undergoing biliopancreatic diversion for other indications. CONCLUSIONS: Gastric bypass and biliopancreatic diversion seem to achieve control of diabetes as a primary and independent effect, not secondary to the treatment of overweight. Although controlled trials are needed to verify the effectiveness on nonobese individuals, gastric bypass surgery has the potential to change the current concepts of the pathophysiology of type 2 diabetes and, possibly, the management of this disease.  相似文献   

6.
Bariatric surgery is a safe and effective method for achieving durable weight loss for patients with morbid obesity. Gastric restrictive procedures include vertical banded gastroplasty and gastric banding. Malabsorptive procedures include long-limb gastric bypass, biliopancreatic diversion, and biliopancreatic diversion with duodenal switch. The gastric bypass has features of both restriction and malabsorption. The laparoscopic approach to bariatric surgery has substantially improved postoperative recovery. Careful patient selection and preoperative work-up are extremely important. A number of medical comorbidities are improved after surgically-induced weight loss.  相似文献   

7.
目的探讨腹腔镜胃旁路手术和迷你胃旁路术对合并2型糖尿病的病态肥胖症患者的治疗效果。方法7例伴有2型糖尿病的单纯性肥胖症患者中1例行腹腔镜胃旁路术.6例行腹腔镜迷你胃旁路术,观察患者术后2型糖尿病治疗效果。结果7例患者手术顺利,手术时间100~170(平均135)min。无手术并发症。术后平均随访1年,体质量平均减少24.3kg,均已停用所有降糖药物,各项糖尿病检查指标均正常。结论腹腔镜胃旁路术或迷你胃旁路术对2型糖尿病短期治疗有效。  相似文献   

8.
Background: During the last 5 years, the performance of bariatric operations has doubled via our outpatient obesity clinic. Currently, 52% of the patients presenting for weight loss are interested in bariatric surgery. Gastric banding and Roux-en-Y gastric bypass are the two laparoscopic procedures proposed. The aim of this study was to evaluate the impact of preoperative teaching on the patients' surgical option. Methods: All the candidates for bariatric surgery were submitted to preoperative teaching and those between February 2001 and December 2002 are the subject of this study. The teaching consisted of 3 weekly interactive 2-hour sessions. During the first session, the patients were asked about the type of operation that they had in mind: gastric banding, gastric bypass, or not yet decided. The same questions were repeated at the end of the third session, with an additional possible answer: no surgery. Results: 297 consecutive patients with a BMI >35 kg/m2 with at least one severe co-morbidity, were submitted to preoperative teaching. 80% of the patients were women. Median age was 41 years. Before teaching, 68 patients (23%) were uncertain, 100 (34%) favored gastric banding, and 129 (43%) wanted a gastric bypass. After education, only 3 patients (1%) remained uncertain, 45 (15%) changed their surgical option, and 27 (9%) declined surgery. The proportion of patients opting for gastric banding decreased from 34% to 20%, whereas those electing bypass increased from 43% to 70%. Conclusions: Preoperative training provides an informed and better patient selection for bariatric surgery. It helps the patients understand the various surgical options, and makes their decision easier.  相似文献   

9.
Gastric bypass as a 90 per cent gastric exclusion operation was used in 393 patients with massive obesity to limit food intake. Stomal ulcer has occurred in 1.8 per cent of such patients or one ulcer per 140 man years of observation. The studies of indwelling fundic pH and of gastric acid secretion from the excluded stomach indicate that acid secretion is reduced after gastric bypass but that the acid, unbuffered by food in the excluded stomach, results in a lowered gastrin secretion after a meal. Thus, gastric bypass in inhibitory to acid secretion in most morbidly obese patients who do not have known acid peptic disease.  相似文献   

10.
Gastric bypass in patients with morbid obesity should be an excellent antireflux procedure, because no acid is produced at the small gastric pouch and no duodenal reflux is present, due to the long Roux-en-Y limb. Five hundred fifty-seven patients with morbid obesity submitted to resectional gastric bypass, and routine preoperative upper endoscopy with biopsy samples demonstrated 12 patients with Barrett’s esophagus (2.1%) and three patients with intestinal metaplasia of the cardia (CIM). An endoscopic procedure was repeated twice after surgery, producing seven patients with short-segment Barrett’s esophagus (BE) and five patients with long-segment BE. Body mass index (BMI) decreased significantly, from 43.2 kg/m2 to 29.4 kg/m2 2 years after surgery. Symptoms of reflux esophagitis, which were present in 14 of the 15 patients, disappeared in all patients 1 year after surgery. Preoperative erosive esophagitis and peptic ulcer of the esophagus healed in all patients. There was regression from intestinal metaplasia to cardiac mucosa in four patients (57%) with short-segment BE, and in one patient (20%) with long-segment BE. Two (67%) of three cases with CIM had regression to cardiac mucosa. There was no progression to low- or high-grade dysplasia. Gastric bypass in patients with Barrett’s esophagus and morbid obesity is an excellent antireflux operation, proved by the disappearance of symptoms and the healing of endoscopic esophagitis or peptic ulcer in all patients, which is followed by an important regression to cardiac mucosa that is length-dependent and time-dependent.  相似文献   

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