减重手术对肥胖症合并非酒精性脂肪性肝病的治疗

非酒精性脂肪性肝病（NAFLD）是发生于非嗜酒者的一系列疾病,病理上以肝细胞大泡性脂肪变为特征,疾病谱包括单纯性脂肪肝、脂肪性肝炎、脂肪性肝纤维化、脂肪性肝硬化．并可发展为肝细胞癌。NAFLD为西方发达国家最常见的肝病．近年在亚太地区的患病率增长迅速．且预计将来仍会进一步增加,这与营养过剩、肥胖、2型糖尿病以及代谢综合征的患病率增加趋势相一致。总之,NAFLD的发病与体重超重、中心性肥胖、胰岛素抵抗以及代谢综合征关系密切,     

糖尿病患者围手术期的血糖管理

如今,需要接受外科手术治疗的糖尿病患者越来越多.一方面,手术应激可进一步加重糖尿病患者的糖代谢紊乱;另一方面,合并糖尿病也使患者发生围手术期并发症甚至死亡的风险大大增加.因此,对糖尿病患者进行完整的术前评估,良好的术前、术中、术后血糖管理是糖尿病患者手术顺利进行、平稳渡过嗣手术期的重要保证.     

减重代谢手术并发症单中心总结

目的 总结山东大学附属济南市中心医院胃肠外科减重代谢手术的并发症及处理方法.方法 回顾性分析自2013年11月至2018年11月在山东大学附属济南市中心医院胃肠外科接受减重代谢手术的230例患者的病例资料,其中行腹腔镜Roux-en-Y胃旁路术(LRYGB)57例和腹腔镜袖状胃切除术(LSG)173例,总结分析并发症、...     

高龄肺癌患者围手术期的呼吸道管理

1994年6月～2 0 0 3年6月,我们共为6 5例高龄肺癌患者行手术治疗,效果满意。现将患者围手术期的呼吸道管理体会报告如下。临床资料:本组男5 2例,女13例;年龄70～82岁,平均73.8岁。其中吸烟者4 2例,术前合并慢性支气管炎、肺气肿38例,阻塞性肺炎16例;肺功能降低4 2例;行一侧全肺切除8例,肺叶切除5 3例,开胸探查术4例。术后发生肺炎、肺不张15例,呼吸功能衰竭4例(其中2例抢救无效死亡)。呼吸道管理体会:1吸烟可使支气管粘膜的假复层柱状上皮受损,纤毛的运动及排痰功能减弱,支气管分泌物增多和滞留,增加呼吸道感染的机会。因此,患者入院后应反…     

糖尿病患者围手术期的血糖管理

如今,需要接受外科手术治疗的糖尿病患者越来越多.一方面,手术应激可进一步加重糖尿病患者的糖代谢紊乱;另一方面,合并糖尿病也使患者发生围手术期并发症甚至死亡的风险大大增加.因此,对糖尿病患者进行完整的术前评估,良好的术前、术中、术后血糖管理是糖尿病患者手术顺利进行、平稳渡过嗣手术期的重要保证.     

糖尿病患者围手术期的血糖管理

如今,需要接受外科手术治疗的糖尿病患者越来越多.一方面,手术应激可进一步加重糖尿病患者的糖代谢紊乱;另一方面,合并糖尿病也使患者发生围手术期并发症甚至死亡的风险大大增加.因此,对糖尿病患者进行完整的术前评估,良好的术前、术中、术后血糖管理是糖尿病患者手术顺利进行、平稳渡过嗣手术期的重要保证.     

Hepatic histology in obese patients undergoing bariatric surgery

BACKGROUND/AIMS: Obesity is one of the most important clinical associations with non-alcoholic steatohepatitis (NASH). Our aim was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD)/NASH in morbidly obese patients and the risk factors to more aggressive liver disease in this population. METHODS: Review of available studies on prevalence of NAFLD/NASH in severely obese patients submitted to bariatric surgery. RESULTS: Twelve observational and transversal studies were included, with consecutive recruitment, and prospective evaluation of data, summing 1620 patients with severe obesity. Prevalence of steatosis and NASH was 91% (range: 85-98%) and 37% (24-98%), respectively, with unexpected cirrhosis in 1.7% (1-7%). NASH was not related with age or body mass index, but there was an association between male sex and NASH/hepatic fibrosis. Diabetes mellitus and insulin resistance were the conditions most frequently associated with NASH, and hypertension with advanced hepatic fibrosis. CONCLUSIONS: There is a very high prevalence of NAFLD in asymptomatic morbidly obese patients, more than one-third presenting histological criteria for NASH. This review underscores the large variations in prevalence of NASH between studies, calling for the need for a better agreement in the use of the histological criteria.     

Sleep apnea syndrome in the morbidly obese undergoing bariatric surgery

This article suggests that bariatric surgery is the treatment of choice for morbidly obese patients with sleep apnea. All patients lost considerable weight and demonstrated a dramatic symptomatic improvement verified by objective sleep laboratory recordings.     

Respiratory management of the obese patient undergoing surgery

As a reflection of the increasing global incidence of obesity, there has been a corresponding rise in the proportion of obese patients undergoing major surgery. This review reports the physiological effect of these changes in body composition on the respiratory system and discusses the clinical approach required to maximize safety and minimize the risk to the patient. The changes in respiratory system compliance and lung volumes, which can adversely affect pulmonary gas exchange, combined with upper airways obstruction and sleep-disordered breathing need to be considered carefully in the peri-operative period. Indeed, these challenges in the obese patient have led to a clear focus on the clinical management strategy and development of peri-operative pathways, including pre-operative risk assessment, patient positioning at induction and under anesthesia, modified approach to intraoperative ventilation and the peri-operative use of non-invasive ventilation (NIV) and continuous positive airways pressure.     

Feasibility of liver stiffness measurement in morbidly obese patients undergoing bariatric surgery using XL probe

Objective: Prevalence of non-alcoholic fatty liver disease is rising in the Western world and reaches up to 90% in patients undergoing bariatric surgery. Fibroscan^® as a non-invasive tool for liver stiffness measurement (LSM) has several limitations in morbidly obese patients. Only few data exist about the technical feasibility and accuracy of LSM in these patients. We aimed to analyse the feasibility of LSM by Fibroscan^® in bariatric patients.

Materials and methods: In morbidly obese patients, LSM was performed using XL probe. Measurements were termed reliable if 10 successful measurements with a success rate ≥60% and an interquartile range/median (IQR/M) <0.3 were obtained, unreliable if 10 successful measurements were obtained but the IQR/M was >0.3, and they were termed failed if they were neither reliable nor unreliable.

Results: A total of 149 patients were included (87 with liver biopsies); mean BMI was 51.6?±?8.5?kg/m². In 41% LSM using XL-probe was reliable, in 22% unreliable and in 37% failed. Failed LSM was significantly more frequent in patients with higher BMI compared to reliable and unreliable measurements (p?Conclusions: LSM with XL probe is feasible in almost two-thirds of morbidly obese patients with a BMI?≥50?kg/m². Reliable prediction of advanced fibrosis appears to be possible even if formal criteria of successful measurements are not met.     

Prevalence and associated factors of obstructive sleep apnea in morbidly obese patients undergoing bariatric surgery

Sleep and Breathing - Our goal in this study is to determine the prevalence and associated factors of obstructive sleep apnea (OSA) in morbidly obese patients undergoing bariatric surgery. This...     

Cardiovascular benefits of bariatric surgery in morbidly obese patients

Morbid obesity is associated with increased morbidity and represents a major healthcare problem with increasing incidence worldwide. Bariatric surgery is considered an effective option for the management of morbid obesity. We searched MEDLINE, Current Contents and the Cochrane Library for papers published on bariatric surgery in English from 1 January 1990 to 20 July 2010. We also manually checked the references of retrieved articles for any pertinent material. Bariatric surgery results in resolution of major comorbidities including type 2 diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, non‐alcoholic fatty liver disease, nephropathy, left ventricular hypertrophy and obstructive sleep apnea in the majority of morbidly obese patients. Through these effects and possibly other independent mechanisms bariatric surgery appears to reduce cardiovascular morbidity and mortality. Laparoscopic Roux‐en‐Y gastric bypass (LRYGB) appears to be more effective than laparoscopic adjustable gastric banding (LAGB) in terms of weight loss and resolution of comorbidities. Operation‐associated mortality rates after bariatric surgery are low and LAGB is safer than LRYGB. In morbidly obese patients bariatric surgery is safe and appears to reduce cardiovascular morbidity and mortality.     

超级肥胖患者腹腔镜代谢手术的手术室护理操作要领

目的 探讨超级肥胖患者腹腔镜代谢手术中手术室护理操作要领.方法 分析我院2016年1月至2020年1月实施的30例超级肥胖患者的腹腔镜代谢手术的手术室中遇到的相关风险因素与采取的相应解决措施,提出较安全、精准、完善的超级肥胖患者手术室护理操作要领.结果 通过处理导尿困难、外周静脉穿刺及中心静脉置管困难、血压监测困难、体...