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1.
我国已经进入到减重与代谢手术的快速发展期,我们在减重与代谢外科专科化发展、手术规范化培训、学术交流及科学研究方面不断探索,越来越多的中国减重与代谢外科声音在国际上发出。如何做好量和质的同步发展,是我们每一位减重与代谢外科医师应思考的问题。  相似文献   

2.
减重代谢外科通过重建胃肠道的解剖结构达到减少摄食量和营养吸收的目的,并同时产生代谢调节作用。目前,减重代谢外科存在以下几个热点研究问题:减重手术治疗糖尿病的确切机制、肥胖与肿瘤发病的关系、低体重病人行代谢手术的依据、个体化手术设计和手术方式的选择、以及建立临床数据库并基于此进行更深一层的研究,这些问题均关系到减重代谢外科的地位及发展。在减重代谢外科蓬勃发展的时代,积极加强基础研究与临床研究,尤其是结合了基础与临床的转化研究,对于学科的健康有序发展,意义尤为重大。  相似文献   

3.
减重代谢外科通过重建胃肠道的解剖结构达到减少摄食量和营养吸收的目的,并同时产生代谢调节作用。目前,减重代谢外科存在以下几个热点研究问题:减重手术治疗糖尿病的确切机制、肥胖与肿瘤发病的关系、低体重病人行代谢手术的依据、个体化手术设计和手术方式的选择、以及建立临床数据库并基于此进行更深一层的研究,这些问题均关系到减重代谢外科的地位及发展。在减重代谢外科蓬勃发展的时代,积极加强基础研究与临床研究,尤其是结合了基础与临床的转化研究,对于学科的健康有序发展,意义尤为重大。  相似文献   

4.
正减重代谢手术在我国发展已有20余年历史,目前手术例数突破每年1万台。随着手术例数的增加,我国减重手术的术式也越来越规范。学术组织的引领、指南共识的制定、培训机构的建立推动了手术规范化进程。在手术规范化的同时,广大减重外科医师也积极开拓进取,尝试新方法、新技术。  相似文献   

5.
随着全球减重手术开展数量的增多,更安全有效地开展手术并促进病人的早期康复成为减重外科医师追求的重要目标。将加速康复外科(ERAS)理念应用于减重及代谢外科,通过对减重及代谢手术围手术期各项干预措施及临床路径的优化,可以有效地实现大幅度缩短病人住院时间,促进病人康复,进而提高病人满意度的目的。ERAS理念的实施深刻改变了现有减重及代谢外科的模式,合理、规范地开展ERAS对于减重及代谢外科的进一步发展具有重要意义。  相似文献   

6.
近20年来中国减重代谢外科获得蓬勃发展, 是经济发展、生活方式转变的需求, 也是广大外科医师不懈探索的结果。面临大好发展形势的同时, 其专科化发展远远不够, 临床实践中不规范手术依然存在, 专科培训及规范化工作仍处于起步初期, 且随访工作亦为减重代谢外科的严峻挑战。笔者相信:在扎实做好规范化、标准化推进工作的基础上, 减重代谢外科会喜迎光明未来。  相似文献   

7.
目的了解达芬奇手术机器人应用于减重代谢外科的现状及效果。方法检索国内外有关达芬奇手术机器人在减重代谢外科中应用研究的相关文献并进行综述。结果达芬奇手术机器人是近年发展起来的微创外科手术系统,由于其独特的组成结构突破了传统腹腔镜术中视野缺乏、二维成像、镜头不稳、移动范围受限等局限,为操作空间狭小及难度较高的减重代谢手术提供了一定的解决办法。目前达芬奇手术机器人与腹腔镜减重手术主要在手术时间和术后并发症方面有一定的差异。结论近年来达芬奇手术机器人被广泛应用于减重代谢外科,它克服了腹腔镜辅助减重手术的诸多限制,其安全、可行,而且临床效果相似,为减重代谢外科提供了一种新的术式选择。  相似文献   

8.
减重与代谢外科的临床研究已经广泛地推动了该领域的发展和临床实践。在欧美等国家, 早在20世纪80年代, 就已经通过临床研究尝试回答减重代谢手术的科学问题, 推动了行业指南的不断更新, 实现了临床实践的标准化, 进而推动了手术的广泛应用, 也推动了关键证据的积累, 使得减重手术的代谢获益得到认可。在领域内的重大问题形成共识之后, 临床研究又进一步促进了学科的深度和广度的发展。我国的减重与代谢外科临床实践相较于国外开展较晚, 临床研究仍处于起步阶段, 高质量的临床研究较少, 且对该领域的贡献有限。但是我国的临床实践开展广泛、患者群体大、手术质量高, 可通过开展临床研究的标准化引领、广泛的合作以及规范化数据管理等方式, 探索临床研究发展的道路。  相似文献   

9.
目的 了解保留幽门的胃旁路手术在减重代谢外科的应用效果。方法 检索国内外有关保留幽门的胃旁路手术的相关文献并进行综述。结果 近年,保留幽门的胃旁路手术逐渐应用于临床,相比其他减重手术而言,其减轻体质量及控制血糖的临床效果较好,它不仅为重度肥胖患者的手术治疗提供了新术式,而且促进了减重代谢外科的发展。结论 保留幽门的胃旁路手术作为减重代谢外科的新术式是安全和可行的。  相似文献   

10.
目的:探究用新鲜冰冻尸体进行腹腔镜减重代谢手术的教学效果。方法:2018年12月至2019年12月,用新鲜冰冻尸体开展3次腹腔镜减重代谢手术学习班。对学员发放问卷,统计教学前、后知识掌握程度及课程评价。结果:参加第3次培训13名学员的减重代谢手术相关知识问卷结果显示,培训前平均(6.15±1.51)分,培训后平均(8.08±1.20)分,分数前、后差异有统计学意义(P0.05)。参加前2次培训22名学员的教学反馈问卷调查中,16名(72.7%)认为新鲜冰冻尸体教学有助于提高对术中解剖结构的认识,19名(86.4%)认为有利于培训后新开展减重代谢手术,13名(59.1%)拟培训后新开展减重代谢手术。结论:新鲜冰冻尸体行腹腔镜减重代谢手术教学切实可行,有利于减重代谢手术的规范化发展。  相似文献   

11.
肥胖代谢外科在我国已发展20年,起步晚、起点高、发展快。因减重手术数量逐年增加,各类临床、基础研究开展逐渐增多,我国也逐渐成为世界范围内推动肥胖代谢外科发展的重要力量。肥胖代谢外科快速发展同样面临诸多问题,如手术适应证是否明确,手术方式的选择,术后并发症的预防与处理。笔者将深入探讨和剖析肥胖代谢外科发展过程中的问题,以...  相似文献   

12.
BackgroundSurgical quality assurance methods aim to ensure standardization and high quality of surgical techniques within multicenter randomized controlled trials (RCTs), thereby diminishing the heterogeneity of surgery and reducing biases due to surgical variation. This study aimed to establish the measures undertaken to ensure surgical quality within multicenter RCTs investigating bariatric and metabolic surgery, and their influence upon clinical outcomes.MethodsAn electronic literature search was performed from the Embase, Medline, and Web of Science databases to identify multicenter RCTs investigating bariatric and metabolic surgery. Each RCT was evaluated against a checklist of surgical quality measures within 3 domain: (1) standardization of surgical techniques; (2) credentialing of surgical experience; and (3) monitoring of performance. Outcome measures were postoperative weight change and complications.ResultsNineteen multicenter RCTs were included in the analysis. Three studies undertook pretrial education of surgical standard. Fourteen studies described complete standardization of surgical techniques. Four studies credentialed surgeons by case volume prior to enrollment. Two studies used intraoperative or video evaluation of surgical technique prior to enrollment. Only two studies monitored performance during the study. Although there were limited quality assurance methods undertaken, utilization of these techniques was associated with reduced overall complications. Standardization of surgery was associated with reduced re-operation rates but did not influence postoperative weight loss.ConclusionThe utilization of methods for surgical quality assurance are very limited within multicenter RCTs of bariatric and metabolic surgery. Future studies must implement surgical quality assurance methods to reduce variability of surgical performance and potential bias within RCTs.  相似文献   

13.
BackgroundMetabolic and bariatric surgery (MBS) in adolescents has been shown to be safe and effective, but current practice patterns are variable and poorly understood. The aim of this study is to assess current MBS practice patterns among pediatric surgeons in the United States.MethodsAmerican Pediatric Surgical Association members were surveyed on current bariatric surgery practices.ResultsFour hundred and three (40%) surgeons out of a total of 1013 pediatric surgeons responded to the survey. Only 2 respondents had additional training in MBS (0.5%). One hundred thirty-two (32.6%) report that their practice participates in metabolic and bariatric surgery, with 123 (30.4%) having a specific partner specializing in MBS. Most respondents (92%) stated that they believe high volume is associated with better outcomes with regard to MBS. Only 17 (4.2%) surgeons performed a metabolic and bariatric surgery in the last year. All routinely perform sleeve gastrectomy as their primary procedure. Most (82%) perform procedures with an additional surgeon, either another pediatric surgeon (47%) or an adult bariatric surgeon (47%). All pediatric bariatric surgeons responded that they believe high volume led to better outcomes. Adolescent MBS programs most commonly included pediatric nutritionists (94%), pediatric psychologists (94%), clinical nurses (71%), clinical coordinators (59%), pediatric endocrinologists (59%), and exercise physiologists (52%).ConclusionOnly 17 (4.2%) respondents had performed a metabolic and bariatric surgery in the past year, and few of those had additional training in MBS. Future work is necessary to better understand optimal practice patterns for adolescent metabolic and bariatric surgery.Type of studyReview article.Level of evidenceLevel III.  相似文献   

14.
The use of bariatric surgery in the clinical management of type 2 diabetes has been recently endorsed in the clinical practice recommendations released by the most influential diabetologic associations. However, authoritative critic voices about the application of metabolic surgery in type 2 diabetes continue to appear in diabetologic literature. In this review, we will try therefore to understand what the reasons for this apparent dichotomy. In this paper, we revised what we believe are now clear evidences about the role of bariatric surgery in the treatment of type 2 diabetes in patients with morbid obesity: the efficacy of bariatric surgery in metabolic control, the existence of plausible weight-independent metabolic mechanisms at least in some bariatric procedure, and the importance of the early referral to surgery in patients with firm indications. However, we stressed also the lack of clear high-quality long-term data about the effects of bariatric surgery in the prevention of both macro- and micro-vascular hard endpoints in patients with type 2 diabetes. The accrual of these results will be critical to completely clarify the risk/benefit ratio of bariatric surgery in diabetes, as compared to current pharmacologic therapies. This may be particularly important in patients in which data on long-term efficacy are still not completed, such as in patients with lower BMI levels.  相似文献   

15.
李威杰 《消化外科》2013,(12):891-893
随着肥胖问题的日益严重以及微创减重手术的发展,减重手术在近年来呈现跳跃式的发展,也发展出独立的减重外科分支。减重手术不但是病态性肥胖患者目前唯一有效的治疗方法,而且逐渐发展为代谢性手术,为难治性的肥胖合并糖尿病患者提供了一种新的治疗方法。减重手术的术式数十年发生了很大的变化,目前的减重手术经过不断的改进及发展,已成为一种相对安全和有效的外科治疗方法。新的代谢性手术仍在不断地发展,预期对未来糖尿病的治疗会有很大的突破。减重外科的专科化发展则是减重手术蓬勃发展后的必然趋势,独立的减重外科可以专注于减重手术的服务以及质量提升,对减重及代谢手术的专业训练以及研究发展也都有很大的帮助。随着文明化生活方式的影响,肥胖及糖尿病将会持续成为这个时代重要的健康问题,减重外科的发展更是值得期待。  相似文献   

16.
减重及代谢外科起源于20世纪50年代,经过半个多世纪的发展,经历了从有创向微创的转变,也从单纯的减重外科进化为治疗肥胖及相关代谢紊乱的减重及代谢外科,成为一个具有完整体系的学科,其治疗手段也在不断丰富和优化,包括经自然腔道的内镜下减重技术、无创的可吞咽式胃内球囊技术、精准的外科机器人辅助手术、减重药物等,并通过完善的临床数据收集分析,促使整体医疗质量和病人安全持续提升。对一些手术方式也正在进行客观的审视评价,包括单吻合口胃旁路术、单吻合口十二指肠转位手术以及胃袖状切除术等。此外,学科内涵也在高质量临床研究的支撑下不断丰富,治疗焦点从肥胖症及相关代谢性疾病向心脑血管疾病拓展。  相似文献   

17.
Contemporary outcomes of bariatric surgery are not well defined. Our aim was to document the outcomes of bariatric surgery on the basis of surgeon caseload and affiliation. We analyzed prospectively collected Florida-wide hospital discharge data. Forty-four surgeons undertook bariatric surgery in 933 patients during 1999. The ten surgeons who averaged more than two operations/month undertook 764 operations; 162 (17%) were done by academic surgeons. Complications [14% vs 7% (P = 0.008, chi-square)], length of stay (5 +/- 0.7 vs 4 +/- 0.1 days), and hospital charges (in thousands) ($31 +/- 4.0 vs $24 +/- 0.4) were greater in academic than in community-based centers (P < 0.05, Wilcoxon rank-sum). However, 36 per cent of patients operated upon by academic surgeons had a high Severity Index compared with only 16 per cent of patients operated upon by community-based surgeons (P < 0.001, chi-square). In high-risk patients complications (40% vs 46%), length of stay (7 +/- 1.0 vs 6 +/- 0.4 days), and hospital charges (in thousands) ($42 +/- 6 vs $35 +/- 2) were similar between academic and community-based surgeons. We conclude that outcomes of bariatric surgery in high-risk patients are similar among academic and community-based surgeons. Academic surgeons undertake bariatric surgery in high-risk patients more frequently than community-based surgeons, which underlies their increased complication rate. These prospectively collected data reflect surgical outcomes more accurately than clinical series and will impact our practice of bariatric surgery.  相似文献   

18.
中国减重代谢外科经历了曲折却充满收获的20年,但目前依然存在诸多不足,主要包括代谢内、外科对于手术中长期疗效的分歧,病人对减重手术认识不足、认可度低,以及部分减重代谢外科团队手术适应证掌握不准确、手术方式选择不当、手术技术参差不齐、术后并发症处理不及时、术后随访欠规范等一系列问题。在行业协会的正面引导下,落实数据采集、汇报制度,行业培训的规范化,倡导多中心前瞻性研究的标准化管理,加大媒体的宣传力度,必将使我国减重代谢外科突破瓶颈,迎来下一个飞速发展的新起点。  相似文献   

19.
近些年,我国减重及代谢外科得到长足的发展,年手术量已达到万例,但是全国范围内手术适应证和手术方式的同质化仍然是一个难题。减重及代谢外科的稳步持续发展离不开手术质量控制。应建立严格的减重及代谢外科准入制度,严格控制手术适应证,同时术前须采取多学科综合治疗协作组(MDT)模式对病人进行详细的评估。除手术安全性外,还应关注手术的中远期效果,包括体重下降、代谢指标缓解以及后期体重反弹问题,这些均与手术质量息息相关。此外,手术治疗后需要建立病人的详细档案并终生随访。  相似文献   

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