Ts'ebeliso ea bongaka la bariatric bakeng sa mofuta oa 2 lefu la tsoekere: ho thusa ngaka e sebetsang. Mongolo oa sengoloa sa saense o ikhethang - Lingaka le Tlhokomelo ea Bophelo

Ho ea ka WHO, palo ea batho ba batenya lefatšeng ka bophara ba 2014 ba feta limilione tse 600, mme ba boima bo fetang limilione tse 1,9. Ho ata ha T2DM lefatšeng ka bophara ho hakanyetsoa ho 9% ho batho ba baholo ba fetang lilemo tse 18 mme ho boletsoe esale pele ke WHO hore lefu la tsoekere e tla ba sesosa sa 7 sa pele sa lefu ka 2030 (* www.who.int /). Re u hlokomelisa likhopolo tse fosahetseng tse leshome tse amanang le kalafo ea botena le lefu la tsoekere.

Ho nona ke bothata ba linaha tse tsoetseng pele haholo eseng Russia

Eseng joalo joalo. Kannete, botenya linaheng tse tsoetseng pele hajoale ke bothata bo boholo haholo. Empa ho na le ntho e le 'ngoe. Ho nona haholo linaheng tse tsoetseng pele haholo ho ama karolo ea baahi e nang le moputso o tlase. Maemong a khaello ea lintho tse bonahalang, baahi ba tloaetse ho ja lijo tse nang le protheine e ngata le palo e kholo ea tse bitsoang li-carbohydrate tse potlakileng. Ka bomalimabe, kajeno Russia e tšoere linaha tse tsoetseng pele mabapi le sekhahla sa kholo ea botena mme, ho latela T2DM.

Kajeno, ke ba 'maloa feela ba bonang botenya e le bothata ba bongaka.

Bongata bo boholo ba baahi mme, ka bomalimabe, lingaka li lemoha hore 'mele o nonneng le botenya haholo ke botle bo botle, bo botle bo botle, ntlo, sechabeng, empa ha se bothata ba bophelo bo botle. Ho feta moo, likhopolo tse fosahetseng tsa setso tse amanang le "batho ba baholo" le "takatso e ntle" ea bophelo bo botle, haholo bongoaneng, li ntse li tloaelehile. Kajeno, tlhokomeliso le tšebetso ea lingaka tsa bongaka, haholo-holo basebetsi ba "boemo ba pele", ha li na tekano e kholo.

Leha e le hore ts'ebetso ea bongaka ea ho buoa ka botona ho feta lilemo tse 60, tlhahisoleseling mabapi le mofuta ona oa kalafo ka bomalimabe e ntse e le ea karolo e nyane haholo ea litsebi.

Leha ho le joalo, ka lebaka la ts'ebetso ea eona e phahameng ho phekolo ea botena, mofuta oa lefu la tsoekere la 2 lefu la tsoekere, dyslipidemia, ts'ebetso ea bongaka ea bariatric ke sebaka se ntlafatsang ka ho fetisisa, empa puisano ea sephetho le katleho e lula e le mohopolo oa puisano ea litsebi tsa litsebi tse "tse nyane" mme joalo ka ha molao o sa fetele ka nqa ea lipuisano tsa mahlale. Batho ba nang le mefuta e feteletseng ea botenya ha ba atise ho utloela sechaba bohloko le ho tšoenyeha ka litsebi ka takatso ea ho thusa. Ho fapana le hoo, khafetsa batho bana ba fetoha ntho e songoang kapa e khopisang. Ho ke ho hlokomeloe hore ka keketseho ea maemo a botenya, lefu la tsoekere le lona le eketseha.

Ho boetse hoa hlokahala ho bolela hore, ho ea ka litsebi, bakuli ba fetang halofo ea bakuli ba nang le T2DM ke batho ba e-so fumanoe.

Ka mantsoe a mang, mokhahlelong ona o sa tsebeng letho ka lefu lena, o latela tšenyo ea methapo ea pelo e amanang le lefu la tsoekere, tšenyo ea methapo ea methapo, e lebisang ho nts'etsopele ea lefu la tsoekere le tšenyo ea methapo ea pelo, bokong, liphihlelo tse tlase, liphio le retina.

Mofuta oa 2 oa lefu la tsoekere ke lefu le sa foleng le sa foleng

Ka sebele, T2DM esale e nkuoa e le lefu le sa foleng le sa foleng. Polelo ena e sebetsa ka tsela e itseng. Ka mantsoe a mang, ke bakeng sa bakuli ba fumanang kalafo e hlokofatsang.

Khahlano le semelo sa kalafo e hlokofatsang, sephetho se phahameng sa kalafo ke matšeliso bakeng sa T2DM - ke hore, ho fihlella boemo boo ho bona ho ka eketsang boemo ba tsoekere e haufi le teboho e tloaelehileng mehatong e fapaneng ea kalafo, haholoholo ts'ebeliso ea lithethefatsi tse fokotsang tsoekere le lijo.

Re ka re liphetho tsa tlhahlobo ea lilemo tse 14 ea bakuli ba nang le lefu la tsoekere la 2, e phatlalalitsoeng ka 1995, ea fetoha phetoho kalafong ea mofuta oa lefu la tsoekere la mofuta oa 2, e bolelang ho hlakoloa ha nako ea mofuta oa lefu la tsoekere la 2, ho bolelang hore boemo ba glycemia ba nakoana ntle le tšebeliso ea lithethefatsi tse fokotsang tsoekere. Lintlha tse tsoang liketeketeng tsa lipatlisiso li bonts'a hore kamora ts'ebetso ea bariatric ea tšoarelo ea nako e telele, ho feta bakuli ba 76% ba nang le T2DM.

Motho e mong le e mong a ka fokotsa boima ba 'mele haholo, ho lekane ho ipehela lijo le ho eketsa ho ikoetlisa!

Boima bo hlile bo ka laoloa ka ho ja le ka tsela ea bophelo. Empa molao ona o sebetsa feela ho fihlela ntlheng e itseng. Bothata ke hore molao-motheo o nepahetseng oa ho theola boima ba 'mele haholo “ja hanyane, o tsamaee ho feta” o na le botena bo bongata maemong a mangata ha o sa sebetsa, hobane ts'ehetso ea lijo e bile teng ka lilemo mme bakuli ba bangata ha ba khone ho ikemela ho hlola.

Ha boima ba 'mele bo ntse bo eketseha, metabolism e senyeha, lithane tse bokellaneng tsa adipose li hlahisa lihormone tsa eona tse ngata ebe ka tsela eo e qala ho laola litlhoko le ho laola boitšoaro ba motho.

Liphetho tsa tlhahlobo ea nako e telele ea bakuli ba kholo li bonts'a hore ha ho na liperesente tse fetang 10 tsa bakuli ba batenya ho feta tekano ba ka fihlelang sephetho se lakatsehang se khahlano le semelo sa kalafo ea setso. Leha ho na le ts'ebeliso ea mananeo a fapaneng a ho fokotsa boima ba 'mele, ho kenyelletsa kalafo ea ho ja, kalafi ea meriana le ts'ebetso ea' mele, ho theosa le lilemo tse 10 ha hoa ka ha fokotseha feela boima ba 'mele, empa keketseho ea 1,6-2%.

Ho buoa bakariatric ke ngaka e buoang ka botle bo botle (cosmetic) mme e ikemiselitse ho ntlafatsa ponahalo ea mokuli

Mohopolo oa menyetla ea mekhoa ea ho buoa ea ho phekola botenya likelellong tsa bakuli 'me ka bomalimabe lingaka tse ngata li amahanngoa le ho buoa ka polasetiki ho tlosa mafura a tlositsoeng a kang liposuction, abdominoplasty. Sena ha se joalo. Mafura a feteletseng a tlatselletsang ke phello ea khaello ea metabolism mme ho tlosoa ha karolo ka boyona ha ho felise sesosa sa pherekano.

Ho fapana le ts'ebetso ea bongaka e sebelisang litlolo, litlamorao tsa ho buuoa ka bariatric ha li lebisoe ho litlamorao, empa ho sesosa. Ho feta moo, phello ena ha e felle feela ho fokotseha ha palo ea mafura a subcutaneous.

Lintlha tse tsoang liphuputsong tsa nako e telele ho feta li-cohorts tse kholo tsa bakuli li bonts'a hore kamora ho kenella ka mekhoa e mengata ea bariatric, tšoarelo ea T2DM, ke hore, phihlello ea litekanyetso tse tloaelehileng tsa tsoekere ntle le kalafo e fokotsang tsoekere, e bonoa maemong a 76,8%, hyperlipidemia ho 83%, le khatello ea mali ea methapo ho 97%. Ho latela liphetho tsa bafuputsi ba Sweden, ka ho latela nako ea sehlopha sa bakuli (batho ba likete tse 10) ka lilemo tse 12, tekanyo ea batho ba shoang kamora kalafo ea ts'ebetso e ne e le liperesente tse 50 ho feta ho bakuli ba neng ba le kalafong ea kalafo.

Matla a ts'ebetso ea bongaka ea bariatric ho lefu la tsoekere la mofuta oa 2 o amahanngoa le ho fokotseha ha boima ba 'mele

Ebile, ntlafatso nakong ea lefu la tsoekere e se e qalile matsatsing a pele kamora ho buuoa, pejana ho phokotseho e kholo ea boima ba 'mele. e fokotsa boima ba 'mele. Ho na le lintlha tse 'maloa tse amang lefu la tsoekere.

Ts'ebetso e baka maemo a macha bakeng sa phetoho e matla ea ho ja lijo tse nang le khalori e tlase, khahlano le boemo ba tsoekere maling maling bo fokotsoang haholo kapa bo tloaelehileng. Ntle le moo, tlasa maemo a macha, 'mele o hlahisa lihomone tsa oona, tse nang le litlamorao tse ngata.

Tse ithutoang haholo ke tlhasimollo ea tlhahiso ea "insulin" e kopantsoeng le takatso ea lijo le phello ea ho khutlisetsa lisele tsa pancreatic beta. Litla-morao tsa meriana ea tse ling tsa lihormone tsena hajoale li kenyellelitsoe li-regimens tsa mehleng ena bakeng sa kalafo e bolokang lefu la tsoekere ea mofuta oa 2.

Ho buuoa ka Bariatric ke ts'ebetso ea bongaka e nang le mathata a mangata.

Eseng bakuli feela, empa le lingaka li na le maikutlo a fosahetseng mabapi le mathata a mangata, a amanang haholo le nalane ea ho buuoa bakeng sa botona. Taba ke hore ts'ebetso ea pele ea bariatric e entsoe lilemo tse fetang 60 tse fetileng, mme ka mor'a bona ho bile le mathata a mangata. Empa ho tloha ha ts'ebetso ea pele e phetheloa ho fihlela joale, palo e kholo ea ts'ebetso e fapaneng e se e hlahisitsoe.

Moloko o mong le o mong o mocha oa ts'ebetso o ne o tlosa mefokolo ea bao ba fetileng mme o matlafatsa litholoana tsa bona tse ntle. Ho tlameha ho boleloa hore ho hlahisoa ha mahlale a laparoscopic ho kentse letsoho phokotsong e kholo ea palo ea mathata. Hape, lingaka tse buoang le lingaka tse robatsang ka meno li ile tsa hlahisa mokhoa o mocha, o alimiloeng ho tsa bongaka ba bakuli ba nang le mofetše oa mofets'e.

Bohlokoa ba mohopolo o mocha ke ho khutlisetsoa hoa mokuli ka mor'a moo. Ho fihla joale, polokeho ea bongaka ba bariatric e bapisoa le boemo ba polokeho ea ts'ebetso ea ho tepella maikutlong hangata.

Ho buoa ka bongaka ke ts'ebetso ea litho tse "phetseng hantle" tse ke keng tsa fetoloa

Mokhoa o mong o fosahetseng oa boits'oaro bo bobe ke hore ts'ebetso ea bongaka ea bariatric e lebisa khopolong e sa fetoheng ea tlhaho ea tsamaiso ea tšilo ea lijo. Ha e le hantle ha ho joalo. Taba ea mantlha, tloaelo ea "anatomy" ho bakuli ba nang le botenya bo boholo ka ho fetisisa ebile ke taba eo ho buisanoang ka eona, hobane phetoho ka boholo bo tloaelehileng ba litho ka makhetlo a 1.5-2 e ke ke ea bitsoa tloaelo.

Taba ea bobeli, maemong ao ha ho etsoa opereishene ea bariatric, ke ts'ebetso e seng e felisitsoe kapa e lahlehile, e neng e se na monyetla oa ho iphekola.

Kahoo, ts'ebetso ea bongaka ea botena, e etsa liphetoho ho anatomy ka ts'ebetso e seng e senyehile, e baka maemo a macha ao 'mele o khutlelang tšebetsong e tloaelehileng ea' mele.

Ka mantsoe a mang, ts'ebetso ea bariatric, joalo ka ts'ebetso e ngoe le e 'ngoe ea ts'ebetso ea ho buoa, ha e holofe, empa e khutlisetsa ts'ebetso e fetileng e lahlehileng ka lebaka la liphetoho tse phethahetseng tsa anatomical.

Ho buoa bakariatric ke kalafo e turang

Ho latela liphuputso tse entsoeng India, naha e nang le boemo bo etelletseng pele lefatšeng ka lebaka la T2DM, theko e tloaelehileng ea ho phekola mokuli ea nang le T2DM ntle le mathata e ka ba $ 650 ka selemo.

Ho eketsa bothata bo le bong ho eketsa litšenyehelo ka makhetlo a 2,5 - ho fihlela ho $ 1692, ho eketsa mathata a tebileng ho feta makhetlo a 10 - ho fihlela ho $ 6940. Ho fapana le hoo, ts'ebetso ea bariatric e fokotsa litšenyehelo tsa ho phekola mokuli ka makhetlo a 10 - ho fihlela ho $ 65 ka selemo.

E ke ke ea bonts'a karolo ea moruo ea phokotso e kholo ea ho ja lijo kamora ho buuoa, e leng e 'ngoe ea litaba tse sebetsang mabapi le liforamo tsa bakuli ba sebetsanang le liteko tsa bariatric.

Ho buoa ka bongaka ke setla-morao - ka mor'a ho buuoa, mokuli o theola boima ntle le boiteko mme ka sebele o tla fumana sephetho se phethahetseng

Ho na le maikutlo a fosahetseng ka lehlakoreng le fapaneng, le amanang le litebello tse phahameng tse tsoang ho ts'ebetso ea bongaka ea bariatric. Mohopolo ona o hokahane le mohopolo oa bohata oa hore ts'ebetso e tla rarolla mathata ohle a mokuli, mme nakong e tlang ha a hloke ho etsa boiteko. Sena ha se joalo.

Ts'ebetso ke maemo a sa tsoa boptjoa a ho busetsa le ho tloaela ts'ebetso e seng e sa sebetse hantle bakeng sa mokuli - qalo ea tsela e ncha ebile e seng e thata ka linako tsohle.

Mokuli e mong le e mong ea nahanang ho etsa opereishene ea bariatric o hloka ho tseba hore kajeno 10-25% ea bakuli e khutlisa boima ba 'mele ka nako e telele. Boholo ba bakuli bana ke ba sa kang ba bonoa ka nako e telele ke ngaka e fanang ka phepo e nepahetseng kapa ngaka ea bariatric.

Mang kapa mang ea nahanang ho etsa opereishene ea bariatric o hloka ho utloisisa hore kamora ts'ebetso, phetoho ea mokhoa oohle oa bophelo, ho latela mokhoa o nepahetseng oa ho ja le litlatsetso tsa ho ja, ho netefatsa boemo bo nepahetseng ba ts'ebetso ea 'mele, hape, taolo e tlamang ea bongaka e lokela ho etsahala.

Lingoloa li lokisitsoe ke mofuputsi ea etelletseng pele ho Patlisiso ea Laboraka la Thupelo ea Tlhabollo ea Metabolic Diserals, ngaka e buoang Lefapheng la Lichelete la Budgetary Institution "North-West Medical Institute e bitsoang Acad. V.A. Almazova

Sengoloa sa sengoloa sa saense lefapheng la bongaka le la bophelo ba sechaba, mongoli oa pampiri ea mahlale - Yershova Ekaterina Vladimirovna, Troshina Ekaterina Anatolyevna

Ts'ebeliso ea ts'ebetso ea bongaka ea bariatric ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere mellitus (T2DM) e na le litšobotsi tsa eona. Thutong ena, ho bontšitsoe matšoao le litlolo bakeng sa ts'ebetso ea bariatric, ho kenyelletsa le e tobileng boteng ba T2DM. Mefuta e fapa-fapaneng ea ts'ebetso ea bariatric le mekhoa ea phello ea bona ho carbohydrate le lipid metabolism li hlalositsoe. Liphetho tsa ho buuoa ka thibelo le shunt bariatric ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere oa bontšoa. Litlhoko tsa ts'ebetso ea bariatric li hlahisoa 'me likarolo tsa ho lekola ts'ebetso ea tsona li fanoa, ho kenyelletsa tšoarelo ea T2DM kamora ho kena lipakeng tsa bariatric. Lisosa tsa hypoglycemia ea post-bariatric, hammoho le bolepi ba kemiso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso mabapi le taolo ea metabolic ho bakuli ba nang le botenya le T2DM li ea hlahlojoa.

Ts'ebeliso ea bongaka ba bariatric ho bakuli ba nang le lefu la tsoekere la mofuta oa 2: thusa ngaka

Ts'ebeliso ea ts'ebetso ea bongaka ea bariatric ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere mellitus (T2DM) e na le likarolo tsa eona. Thutong ena re tšohla matšoao le li-contraindication bakeng sa ts'ebetso ea bongaka ea bariatric, ho kenyelletsa le e itseng, e.k. boteng ba lefu la tsoekere la mofuta oa 2. Mefuta e fapa-fapaneng ea ts'ebetso ea bongaka ea bariatric le mekhoa ea litlamorao tsa tsoekere le molomo> ts'ebetso ea bariatric ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere, re hlahisa litlhokahalo tsa ts'ebetso ea bongaka le litekanyetso tsa tlhahlobo ea ts'ebetso ea eona, ho kenyelletsa tšoarelo ea lefu la tsoekere la mofuta oa 2 kamora ho buuoa ka bariatric. . Mabaka a postological hypoglycemia, hammoho le bolepi ba katleho ea ts'ebetso ea bongaka ea bariatric bakeng sa taolo ea metabolic ho bakuli ba nang le botenya le lefu la tsoekere la mofuta oa 2.

Sengoloa sa mosebetsi oa mahlale ka sehlooho "Tšebeliso ea bongaka ba bariatric bakeng sa lefu la tsoekere la 2: ho thusa setsebi"

Ho nona haholo le metabolism. 2016.13 (1): 50-56 DOI: 10.14341 / OMET2016150-56

Tšebeliso ea bongaka la bariatric bakeng sa lefu la tsoekere la mofuta oa 2: ho thusa ngaka

Ershova E.V. *, Troshina E.A.

Federal State Budgetary Institution Endocrinological Science Science Center ea Lekala la Bophelo la Russia, Moscow

(Motsamaisi - Setsebi sa RAS II. Dedov)

Ts'ebeliso ea ts'ebetso ea bongaka ea bariatric ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere mellitus (T2DM) e na le litšobotsi tsa eona. Thutong ena, ho bontšitsoe matšoao le litlolo bakeng sa ts'ebetso ea bariatric, ho kenyelletsa le e ikhethang - ka pel'a T2DM. Mefuta e fapa-fapaneng ea ts'ebetso ea bariatric le mekhoa ea phello ea bona ho carbohydrate le lipid metabolism li hlalositsoe. Liphetho tsa ho buuoa ka thibelo le shunt bariatric ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere oa bontšoa. Litlhoko tsa ts'ebetso ea bariatric li hlahisoa 'me likarolo tsa ho lekola ts'ebetso ea tsona li fanoa, ho kenyelletsa tšoarelo ea T2DM kamora ho kena lipakeng tsa bariatric. Lisosa tsa hypoglycemia ea post-bariatric, hammoho le bolepi ba kemiso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso mabapi le taolo ea metabolic ho bakuli ba nang le botenya le T2DM li ea hlahlojoa.

Mantsoe a bohlokoa: botenya, mofuta oa 2 lefu la tsoekere, ts'ebetso ea bongaka ea bariatric

Ts'ebeliso ea ts'ebetso ea bongaka ea bakariatric ho bakuli ba nang le lefu la tsoekere la mofuta oa 2: thusa ngaka Ershova E.V. *, Ttoshina E.A.

Setsi sa Patlisiso sa Endocrinology, Dmitriya Ulyanova St., 11, Moscow, Russia, 117036

Ts'ebeliso ea ts'ebetso ea bongaka ea bariatric ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere mellitus (T2DM) e na le likarolo tsa eona. Thutong ena re tšohla matšoao le li-contraindication bakeng sa ts'ebetso ea bongaka ea bariatric, ho kenyelletsa le e itseng, e.k. boteng ba lefu la tsoekere la mofuta oa 2. Mefuta e fapa-fapaneng ea ts'ebetso ea bongaka ea bariatric le mekhoa ea litlamorao ho tsoekere ea glucose le lipid metabolism. Re bonts'a sephetho sa ts'ebetso ea bongaka e thibelang le e fetang kapele ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere, re hlahisa litlhokahalo tsa ts'ebetso ea bongaka le litekanyetso tsa tlhahlobo ea ts'ebetso ea eona, ho kenyelletsa le ho hlakoloa ha lefu la tsoekere la mofuta oa 2 kamora ho buuoa ka bariatric. Mabaka a postological hypoglycemia, hammoho le bolepi ba katleho ea ts'ebetso ea bongaka ea bariatric bakeng sa taolo ea metabolic ho bakuli ba nang le botenya le lefu la tsoekere la mofuta oa 2. Mantsoe a bohlokoa: botenya, mofuta oa 2 lefu la tsoekere, ho buuoa ka bariatric.

* Sengoli sa mongoli oa nepenucKu / Sengolo - [email protected] DOI: 10.14341 / 0MET2016150-58

Ho buoa ka bongaka (ho tsoa ho Bagerike. Bago - boima, bo boima, boima) ke mehato ea ho buoa e etselitsoeng mochini o silang lijo ho theola boima ba 'mele (MT).

Lilemong tse mashome tsa morao tjena, mekhoa ea ho buoa e sebelisitsoe haholo ho potoloha le lefats'e ho phekola botenya haholo, mme ho na le tloaelo e hlakileng ea ho eketsa palo ea ts'ebetso e etsoang le ho atolosa palo ea linaha tseo ho tsona ho buoang batariatric ho ntseng ho ata haholo.

Lipakane tsa kalafo ea ho buuoa ka botenya:

♦ ka lebaka la phokotseho e kholo ea MT, e ama tsela eo mafu a ntseng a eketseha ka eona ha MT e eketseha (mofuta oa 2 lefu la tsoekere (lefu la tsoekere la 2), khatello ea mali ea methapo, lefu la apnea la bosiu, ho hlohlona ha ovari, jj.),

Ntlafatsa bophelo ba bakuli ba nang le botenya.

Matšoao a ho buuoa ka bariatric

Phekolo ea kalafo ea botena e ka etsoa haeba mehato ea pele e thibelang ho fokotsa MT ho bakuli ba lilemo li 18 ho isa ho 60 ha e sebetse ka:

♦ morbid obesity (boima ba 'mele (index ea BMI)> 40 kg / m2),

♦ botenya le BMI> 35 kg / m2 mmoho le mafu a matla a kopaneng a sa laoloeng ke liphetoho tsa mekhoa ea bophelo le kalafo ea lithethefatsi. Tlolo ea molao mabapi le ho buuoa ka bariatric ke ho ba teng ha mokhethoa:

Joala, lithethefatsi kapa joala bofe kapa bofe.

♦ exacerbation ea peptic ulcer ea ka mpeng kapa duodenum,

Liphetoho tse ke keng tsa fetoloa tse etsoang ke litho tsa bohlokoa (ho hloleha ho sa feleng ha pelo ea sehlopha sa IV - IV se sebetsang hantle, ho senyeha hoa sebete kapa liphio),

Ho se utloisise likotsi tse amanang le ts'ebetso ea bariatric,

Ho hloka melao ea ts'ebetso ea tieo ea kemiso ea tšebetso ea postoperative. Lits'ebetso tse khethehileng bakeng sa ho rala lingaka tsa bariatric ho bakuli ba nang le botenya le lefu la tsoekere ke:

♦ li-antibodies tse ntle ho li-glutamic acid decarboxylase kapa liselehans islet,

♦ C-peptide ha ke fumane seo u se hlokang? Leka ts'ebeletso ea khetho ea lingoliloeng.

Ts'ebetso eohle ea bariatric, ho latela ts'ebetso ea bona ho anatomy ea gastrointestinal, e ka aroloa ka lihlopha tse 3: thibelo, shunting (malabsorption) le e tsoakiloeng. Khetho ea maano a ho buuoa a ipapisitse le tekanyo ea botenya, lintlha tse ikhethang tsa mathata a amanang le metabolic le maloetse, litšobotsi tsa kelello tsa mokuli, mofuta oa boitšoaro ba ho ja le ho ikemisetsa ha mokuli kalafo le mekhoa ea bophelo. Khafetsa, khetho ea mokhoa oa ho buoa e khethoa ke boiphihlelo ba ngaka ea ngaka e buoang.

Ts'ebetso e thibelang (gastro-limited) e etselitsoe ho fokotsa boholo ba mpa. Nakong ea ts'ebetso e thibelang, mpa e arotsoe likarolo tse peli, e siea boholo ba karolo e kaholimo e sa feteng 15 ml. Sena se ka fihlelleha ka ho emisa ka mpeng ka mpeng ka karolo e nyane (vertical gastroplasty (VGP), Fig. 1a), kapa ka ho sebelisa silicone cuff e ikhethang (bandable gastric banding (BZ), Fig. 1b). Mokhoa o mong oa sejoale-joale - ho khutlisetsa pelehi ka mpeng (PRG, Figure 1), ho tlosa boholo ba mpa ka mothapo o mosesane sebakeng sa phallo e tlase ea 60-100 ml.

Mochine oa litlamorao tsa metabolic tsa lithibelo tse thibelang bariatric

Kameho ea ts'ebetso e thibelang mabapi le ho ntlafatsa litekanyetso tsa metabolic ka mofuta oa 2 lefu la tsoekere e thehiloe ho:

Phetisetso ea bakuli nakong ea ts'ebetso ea pele ho ts'ebeliso ea lijo tsa khalori e tlase,

♦ mme feela kamora moo - ho fokotseha ha boima ba mafura, incl. visceral, e le mohloli oa mafura acids mahala tsamaisong ea methapo ea methapo nakong ea lipolysis, e thusang ho fokotsa ho hanyetsa ha insulin,

♦ moo ho nang le mofetše oa senya - ho tlosoa hoa moea oa mpa oa mpa ka mpeng

Mokotla oa mokotla oa ka mpeng

Mohala oa mpa

Karolo ea pyloric ea mpeng

Sa feiga. 1. Opereishene ea bariatric e thibelang: a) vertical gastroplasty, b) ho tlamisa ka mpeng, ho khutlisetsa metso ea ka mpeng

ho hatella tlala le ho fokotsa takatso ea lijo.

Ts'ebetso e thibelang hanyane ka hanyane e bonoa ke polokeho e itseng le boiketlo ba ho bolaoa, e mamelloa hantle ke bakuli, empa maemong a mangata, haholoholo ka ho nona haholo (kapa botenya haholo, moo BMI> 50 kg / m2), phello ea bona e sa tsitsang. Maemong a tahlehelo ea ts'ebetso e thibelang nakong e telele (mohlala, ka ho pheta-pheta ha suture e emeng, ho fokotseha ha karolo e nyane ea mpeng kapa ho senyeha ha bandage), ho na le menyetla ea 'nete ea ho khutlisetsoa ha MT le ho khutlisetsoa ha DM2.

Motheo oa ketso ea malabsorbent (shunting) le ts'ebetso e kopaneng ke ho ts'oaroa ha likarolo tse fapaneng tsa mala a manyane, tse fokotsang ho monya lijo. Nakong ea gastroshunting (GSh, feiga. 2a), boholo ba mpa, duodenum le karolo ea pele ea mala e nyane li emisitsoe tseleng ea lijo, mme ka li-biliopancreatic shunting (BPS, Figs. 2b le 2c), hoo e ka bang jejunum eohle.

Ts'ebetso e kopaneng, ho kopanya likarolo tse thibelang le tse thibang, e tšoauoa ka ho rarahana ho hoholo le kotsi ea litlamorao tse sa rateheng, leha ho le joalo, e fana ka sephetho se boletsoeng haholoanyane le se tsitsitseng sa nako e telele, mme hape se ama hantle ts'ebetso ea mathata a metabolic le mafu a amanang le botenya, a khethang a bona a mantlha menyetla.

Mekhoa ea ts'ebetso ea GSH ho metabolism ea carbohydrate ho botenya le mofuta oa 2 lefu la tsoekere:

♦ ho qobelloa phetoho nakong ea pele ea ts'ebetso ho ea ho lijo tse nang le khalori e tlase haholo,

Khethollo ea duodenum ho kopaneng le boima ba lijo, e lebisang ho thibelo ea lintho tsa diabetogenic, seo ho thoeng ke li-anti-incretins (bao e ka bang batseteli ke insulinotropic polypeptide (HIP) le glucagon, tse hlahisitsoeng karolong e haufi ea mala a manyane ho arabela ho amoheloa Ho eona lijo le lihlahisoa tse khahlanong le eona kapa ketso ea insulin,

♦ ho ja lijo tse potlakileng karolong e ka thōko ea mala, o thusa ho nts'etsopele ea glucagon-peptide-1 (GLP-1), e nang le ts'ebetso ea "glucose" e itšetlehileng ka "glucose", e tlatsetsang ho seo ho thoeng ke "incretin" e etsahalang ha chyme e fihla mokokotlong oa l-cell mala (monyetla oa ho ba le bothata ba ho lahla litšila - ponahatso e makatsang ka ho fetisisa ea phello ea "incretin") - e beha monyetla oa hore bakuli ba jang lik'habohaedreite tse bonolo tsa mmele),

♦ thibelo ea secretion ea glucagon tlasa ts'usumetso ea GLP-1,

♦ ho potlakisa ho ts'ebetso ea satellite ka lebaka la litlamorao tsa GLP-1 litsing tse tsamaellanang le bokong,

Phokotso ea butle-butle ea boima ba visceral.

Sa feiga. 2. Ho etsa opereishene ea biriatric: a) gastroshunting,

b) HPS e ngotsoe ke Hess-Marceau (“Ad hoc tumbo”) (“Duodenal switch”) 1. duodenum. 2. Khoele e tloaelehileng ea hepatic. 3. Mohoebi

bubble. 4. E ts'oeroe ke mala 5. Biliopancreatic loop.

6. Jugoiliac anastomosis. 7. Cecum. 8. Mala a manyane.

9. Kholone. 10. Rectum. 11. Pancreatic duct.

BPSh phetolelong ea Scopinaro e bolela ho khutlisetsoa ka mpeng, ho siea palo ea kutu ea mpa ho tloha ho 200 ho isa ho 500 ml, ho tšela ka mpeng e nyane ka bolelele ba 250 cm ho tloha sekhutlong sa ileocecal, sebopeho sa enteroenteroanastomosis - cm 50. bolelele ba loop e tloaelehileng ke 50 cm, le 200 ea phepo e nepahetseng cm (Fig.2b).

Ts'ebetso ea BPSH ea mantlha ho ntlafatseng ea Scopinaro mohoanto o itseng oa bakuli e tsamaisana le nts'etsopele ea ulcers ea ka mpeng, ho tsoa mali, le ho lahla methapo. Ka hona, hajoale e sebelisoa haholo.

Ho HPS, ntlafatsong ea Hess - Marceau (Bilio-pancreatic Diversion le Duodenal switchch, ke hore, HPS (ho koeteloa) e nang le duodenum e koetsoe, pyloric e bolokang mofetše oa senya e hlahisoa, mme ileum ha e anastomosed ka kutu ea mpa, empa ka karolo ea pele ea duodenum . Bolelele ba mala bo nkang karolo ea lijo bo ka ba 310-350 cm, eo cm cm 80-100 e abeloeng ho loop e tloaelehileng, cm 200-250 cm ho alimentary (sa feiga. 2c). Melemo ea ts'ebetso ena e kenyelletsa ho bolokoa ha pylorus le phokotso ka lebaka la sena monyetla oa ho nts'etsapele taolo ea ho lahla

ulc sebakeng sa duodenoeleanastomosis, seo hape se tsamaisoang ke ho fokotseha ho hoholo hoa palo ea lisele tsa parietal nakong ea PRG.

Ntle le mekhoa e hlalositsoeng ea ho susumetsa litekanyetso tsa metabolic ho botenya le T2DM maemong a BPS, ho na le:

♦ ho khetha malabsorption ea mafura le lik'habohaedreite tse rarahaneng ka lebaka la ho kenella ka nako ea enzyme ea pancreatic le ho kenella ka har'a lijo, e leng se etsang hore ho fokotsehe ha khatello ea mafura a mangata tsamaisong ea methapo ea methapo, 'me ke eona ntho ea bohlokoahali e khethang ntlafatso ea thupelo ea T2DM,

Phokotso e khethiloeng ea sebopeho sa ectopic lipid mesifa ea marapo le sebete, e ntlafatsang kutloisiso ea "insulin" (hobane ho imeloa ke sebete haholo ka lipid ho tepeng ho amana le bokhoni bo fokolang ba litheipi tsa adipose ho bokella lipids le ho eketsa molumo oa eona, e leng se lebisang ho emeng hoa ectopic ea mafura le lipotoxicity , e thehang motheo oa dyslipidemia le ho hanyetsa insulin ho T2DM). Phihlelo ea ho sebelisa bongaka la bariatric ho bakuli ba batenya hammoho le mafu a metabolic le mafu a ile a lumella Buchwald H. le Varco R. morao ka 1978 ho theha mohopolo oa "ts'ebetso ea" metabolic "e le karolo ea ts'ebetso ea bongaka ea methapo" e le ts'ebetso ea bongaka ea ts'ebetso ea setho kapa tloaelo ka sepheo sa ho fihlela sephetho sa bophelo bo botle. " Nakong e tlang, tloaelo ea nako e telele ea ho sebelisa ho buoa bakariatric ho bakuli ba nang le botenya mme e amanang le eona T2DM, sepheo seo qalong e neng e le ho fokotsa MT, se bonts'itse menyetla e meholo ea ho buuoa ho fihlela puseletso bakeng sa T2DM, e tsoetseng pele khahlanong le semelo sa botena.

Haufinyane, litumelo le li-stereotypes tse mabapi le lefu la tsoekere la 2 li hlahlojoe.

feta. Ka ho khetheha, polelo ea hore tahlehelo e kholo ea MT ke ntho e khethollang ho ntlafatsa taolo ea glycemic ho T2DM, e tsoetseng pele khahlanong le semelo sa botena kamora ho buuoa ka bariatric, e ile ea hlakisoa ke taba ea hore phokotso ea glycemia e hlokometsoe ho tloha libeke tsa pele kamora ho buoa, i.e. nako e telele pele ho fokotseha ho hoholo ha MT. Ka kamohelo e atileng ea mefuta e rarahaneng ea ts'ebetso ea bongaka ea bariatric (GSH, BPSH) ts'ebetsong, ho ile ha totobala hore ho fokotseha ha MT ke ntho e le 'ngoe, empa eseng eona feela ntho e khethollang ntlafatso e boletsoeng esale pele ea metabolism ea carbohydrate ho batho ba batenya ba nang le T2DM.

Boriatric Surgery ufanisi

le lefu la tsoekere la mofuta oa 2

Kaha kalafo ea T2DM e kenyelletsa taolo ea eseng feela taolong ea glycemic, empa le lintlha tsa kotsi ea pelo, ho buuoa ka bariatric ho ka khothaletsoa ho bakuli ba nang le botenya le T2DM ba sa fihlelleng lipheo tsa kalafo ka kalafo ea lithethefatsi, joalo ka ba ntlafatsa haholo mokhoa oa khatello ea methapo ea methapo, dyslipidemia, thibelo ea ho koaleha moea ka nakoana ka boroko, joalo-joalo, ho ekelletsa moo, ba fokotsa sekhahla se bolaeang sa lefu.

Ts'ebetso e thibelang e kenya letsoho pusong ea T2DM: ntlafatso ea metabolism ea carbohydrate libekeng tsa pele kamora ho buuoa ka lebaka la phetisetso ea bakuli lijong tsa ultra-low-calorie, 'me hamorao, ha depositi ea mafura e fokotseha, ho qaleha ha matšeliso a T2DM ho ka etsahala, empa tekanyo ea ona e lekana le palo ea tahlehelo ea MT, ho fapana le ts'ebetso e fokolang. kamora moo ho tloaelehileng ha glycemia e iponahatsang le pele ho fokotseho e kholo ea MT ka lebaka la seo ho thoeng ke "phello e ncha ea lihormone."

Tlhahlobisong ea hae ea meta, Buchwald H. et al. e hlahisitse litholoana tsa lithuto tsohle tse phatlalalitsoeng mabapi le ho buuoa ka bariatric ho tloha ka 1990 ho fihlela 2006. Ho sebetsa hantle ha litlamorao ho carbohydrate metabolism ho bakuli ba nang le botenya

Litlamorao tsa mefuta e fapaneng ea ts'ebetso ea bongaka ea bariatric ho tahlehelo ea MT le thupelo ea Tliniki ea T2DM tafoleng

Letšoao Kakaretso ea BZ VGP GSH BPSH

% tahlehelo MT 55.9 46.2 55.5 59.7 63.6

% ea bakuli ba nang le maemong a tloaelehileng a lipetlele tsa bongaka le tsa laboratori ho T2DM 78.1 47.9 71 83.7 98.9

Liphuputso tsa Tafole ea 2 e bonts'ang taolo ea nako e telele ea glycemic kamora ho buoa ka bariatric ho bakuli ba nang le botenya le T2DM

Bakuli, n Nako ea ho shebella, likhoeli. Liphetho

Herbst S. et al., 1984 23 20 AHbA, c = - 3.9%

Pories W. et al., 1992 52 12 AHbA, c = - 4.4%

Pories W. et al., 1995 146 146 168 91% b-x e na le standardoglycemia 91% b-x e nang le HbA1c e tloaelehileng

Sugerman H. et al., 2003 137 24 83% b-s na Normoglycemia 83% b-s na HbA1c e tloaelehileng

Scopinaro N. et al., 2008 312 120 97% sebelisoa ka HbA1c e tloaelehileng

Scheen A. et al., 1998 24 28 AHbA1c = - 2.7%

Pontiroli A. et al., 2002 19 36 AHbA1c = - 2.4%

Sjostsrom L. et al., 2004 82 24 72% b-x e nang le Normoglycemia

Ponce J. et al., 2004 53 24 80% b-x e nang le standardoglycemia AHbA1c = - 1.7%

Dixon J. et al., 2008 30 24 AHbA1c = - 1.8%

Ha ke fumane seo o se hlokang? Leka ts'ebeletso ea khetho ea lingoliloeng.

mme DM2 e ile ea hlahlojoa ka tekanyo ea bakuli ba nang le maemo a tloaelehileng kapa ntlafatso ponts'o ea bongaka le ea laboratori ea DM2 (lithuto tse 621 tse kenyelletsang bakuli ba 135,246 li kentsoe tlhahlobisong ea meta-(Literata 1, 2).

The normalization ea li-paramente le tsa laboratori bakeng sa T2DM li ile tsa utloisisoa e le ho ba sieo ha matšoao a Tliniki ea T2DM le tlhoko ea ho sebelisa lithethefatsi tse fokotsang tsoekere, ho fihlella glycemia ea ho itima lijo ha ke khone ho fumana seo u se hlokang? Leka ts'ebeletso ea khetho ea lingoliloeng.

Monitoring Tekolo ea bophelo bohle ea bakuli ba ts'ebetso: ho latela lenaneo la European SoE - bonyane 75% ea bakuli e lokela ho lateloa bonyane lilemo tse 5,

♦ mantsoe a tlhatlhobo ea taolo: bonyane nako e le 'ngoe ho likhoeli tse 3 ka selemo sa 1 kamora ts'ebetso, bonyane nako e le' ngoe ho likhoeli tse 6 nakong ea selemo sa bobeli ka mor'a ts'ebetso, ebe - selemo le selemo.

Ho bakuli ba nang le T2DM, e le ho fokotsa kotsi ea hypoglycemia, ts'ebeliso ea lithethefatsi tse theolelang tsoekere ka hanong kapa insulin e lokela ho fetoloa nakong ea pele ea ts'ebetso.

Teko ea katleho ea ts'ebetso ea bongaka ea bariatric ho bakuli ba nang le botenya le T2DM

International Diabetes Federation (IDF) e hlahisitse merero e latelang:

♦ tahlehelo ea MT e fetang 15% ea mantlha,

Ho fihlela boemo ba HbA1c ha ke fumane seo o se hlokang? Leka ts'ebeletso ea khetho ea lingoliloeng.

Ho fihlela boemo ba LDL-C ha ke fumane seo o se hlokang? Leka ts'ebeletso ea khetho ea lingoliloeng.

Mabaka a ntlafatso ea linaha tsa hypoglycemic tse hlalositsoeng kamora lingoliloeng ka mor'a ho buuoa ka bariatric li fana ka tlhokomeliso e itseng nakong ea tlhokomelo ea bakuli nakong ea ts'ebetso ea ts'ebetso.

Ho na le mekhoa e 'maloa e ka lebisang ho nts'etsopele ea libaka tsa hypoglycemic kamora ho buuoa ka bariatric bypass:

1) ho ba teng ha hypertrophy le hyperplasia ea li-b-cell, tse etsahetseng pele ho ts'ebetso mme a e-na le tlhaho ea ho qobella ho hlola ho hanyetsa insulin, mme kamora ho buuoa ka bariatric, ha khatello ea insulin e ntse e fokotseha butle, ba ile ba kenya letsoho maemong a hypoglycemic,

2) litlamorao tsa GLP-1 (boemo ba eona bo eketseha haholo kamora ts'ebetso ea bariatric) ho eketseha ha lisele tsa b le ho fokotseha ha apoptosis ea bona.

3) tšusumetso ea ISU (moelelo oa tšusumetso ha o e-so hlake),

4) phello ea ghrelin (eo boemo ba eona bo fokotsehang haholo kamora ho tlosoa hoa fundus ea mpa), visfatin, leptin, YY peptide (e ntlafatsa phello ea "incretin") le lihormone tse ling.

Khafetsa e phahameng ka ho fetisisa ea hypoglycemia e bonoa kamora ts'ebetso ea GSH (ho 0,2% ea bakuli ba ts'ebetsong), e amanang le katleho e potlakileng ke boima ba lijo tsa karolo e ka thoko ea mala, moo L-lisele tse hlahisang GLP-1 li fumanehang haholo, ho fapana le BPS, eo ho eona BPS e leng ho eona. mala kaofela a manyane a tlameha ho felisoa hore a sililoe. Leha ho le joalo, tlhaiso-leseling mabapi le mofuta oa "hypoglycemia" ea morao-rao e ntse e hanyetsana, 'me ho hlokahala hore lithuto tse ling hape li ithute tse ka holimo le mekhoa e meng ea ho hola.

Mathata a bophelo nakong ea ts'ebeliso le likotsi tsa lefu

Monyetla oa mathata a pele (matsatsing a 30 kamora ho buuoa) kamora mefuta e fapaneng ea lits'ebetso tsa bariatric ha e felle 5-10%.

Tekanyo ea batho ba shoang khahlanong le semelo sa ts'ebetso ea ts'ebetso ea bariatric e tlase haholo, e maemong a 0,1-1.1% mme e bapisoa le letšoao le ts'oanang la ts'ebetso e kenyang butle, joalo ka mohlala, laparoscopic cholecystectomy. Hoo e ka bang 75% ea batho ba shoang nakong ea ts'ebetso ea pele ea ts'ebetso e amana le nts'etsopele ea peritonitis ka lebaka la ho lutla ha litaba ho tloha anastomosis ho ea ka mpeng ea 25 le 25% ke litlamorao tse bolaeang tse amanang le pulmonary embolism.

Ho latela tlhahlobo ea lipalo-palo, palo ea batho ba shoang nakong ea ts'ebetso ea pele ho ts'ebetso ke 0.28%, haholoholo, ka mor'a hore bandaroscopic banding ea mpa e se ke ea feta 0.1%, kamora GSH - 0.3-0.5%, kamora HPS - 0.1-0 , 3%. Karolelano ea batho ba shoang e eketseha ho tloha ka la 30 ho isa selemong sa bobeli ka mor'a ho buuoa ho ea ho 0,35%. Ho bakuli ba kaholimo ho lilemo tse 60, lefu la batho ba bangata le phahame, haholo ha ho e-na le maloetse a amanang le lefu la pelo. Ka kakaretso, ha ho bapisoa le kalafo e hlokofatsang ea botena, ho ikoetlisa ka bariatric ho fokotsa ho shoa hoa bakuli ba ts'ebetsong nakong e telele.

Ho bohlokoa ho hopola hore tekanyo e tlase ea batho ba shoang kamora ho phekoloa kalafo ea botena, ho kenyeletsa ho bakuli ba nang le T2DM, ho ka etsahala feela ha litlhoko tsohle tsa ts'ebetso ea bongaka ea bariatric li lateloa ka hloko ho latela matšoao le li-contraindication, hammoho le litokisetso tse phethahetseng tsa ts'ebetso.

Ba bolelang esale pele ka tsoelopele ea postoperative ea matšeliso a ntlafalitsoeng a amanang le carbohydrate le lipid metabolism ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere.

Ho nahanoa hore lintlha tse hlalositsoeng ka tlase li ka mpefatsa boemo ba lefu la ho pepeseha ha T2DM kamora ho buuoa ka bariatric:

Nako e telele ea T2DM,

Level boemo bo phahameng ba ts'ebetso ea HbA1c,

♦ ho haella ha hyperinsulinemia le ho hanyetsa insulin,

Therapy kalafo ea insulin ea lefu la tsoekere.

Sena se bakoa haholo ke taba ea hore ho bakuli ba nang le lefu la tsoekere la mofuta oa 2, palo ea cells-lisele e fokotseha nako le nako ka lebaka la ho se leka-lekane pakeng tsa apoptosis le neogeneisis, bokhoni ba β lisele tsa ho lefella ho hanyetsa insulin e tlasa nts'etsopele ea lefu la tsoekere la mofuta oa 2 le ea theoha. ka botlalo insulinopenia. Ka hona, ho ka nahanoa ka nepo hore maemong ana a kaholimo ho bakuli, tsoelo-pele ea ho fumana matšeliso bakeng sa metabolism ea carbohydrate e khethoa ke tekanyo ea ap-aposis ea li-b-cell, hammoho le matšoao a tšoaeang bokhoni ba sephiri ba ho sebetsa ha li-b-cell (boemo ba tšimoloho ea C-peptide le ea pele).

Ka kakaretso, tlhaiso-leseling e akaretsang ea lingoliloeng e bonts'a hore, ka khetho e hlokolosi ea ts'ebetso ea bakuli bakeng sa ts'ebetso ea bongaka ea bariatric ka tatellano ho latela matšoao a amoheloang le litlatsetso, nako ea lefu lena e fihlile ho lilemo tse 10-15, taolo ea glycemic e sa khotsofatseng, lilemo tse fetang 50, mme BMI ea mantlha ha e ame letho. tsebong ea kholo ea ho ntlafatsa taolo ea metabolic ho bakuli ba nang le botenya le T2DM kamora ho buuoa ka bariatric, ha feela ts'ebetso e hlahisang insulin ea sele ea b e bolokiloe, ehlile e bolokiloe d ho ea ka boemo ba pele le bo susumetsoang ba C-peptide.

Monyetla oa ho ithuta hape ka katleho le ts'ireletso ea ts'ebetso ea bariatric, e bontšitsoeng ke IDF

E le karolo ea boithuto bo tsoelang pele ba phello ea ho buuoa ka bariatric lintlheng tse fapaneng tsa thupelo le kalafo ea T2DM ho bakuli ba nang le botenya bo fapaneng, ho hlokahala:

♦ boikemisetso ba mekhoa e ts'epahalang ea ho bolela esale pele katleho ea ts'ebetso ea bariatric mabapi le carbohydrate, lipid, purine le mefuta e meng ea metabolism,

♦ Ho etsa lithuto ho lekola katleho ea ts'ebetso ea bongaka ea bakuli ho bakuli ba nang le lefu la tsoekere la 2 le botenya le BMI e ka tlase ho 35 kg / m2,

♦ ho tseba phello ea ts'ebetso ea bongaka ea bariatric ho thibela kapa ho fokotsa tahlehelo e tsoelang pele ea ts'ebetso e hlahisang insulin ea li-b-cell, tšobotsi ea T2DM,

Tlhahlobo ea ♦ phello ea ts'ebetso ea bongaka ea bariatric ho mathata a T2DM,

♦ liteko tse sa reroang ho bapisa litlamorao tsa mefuta e fapaneng ea ts'ebetso ea bongaka ea bariatric ho T2DM.

Doi: Lingoliloeng tsa 10.14341 / OMET2016150-56

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Mofuputsi oa Ershova Ekaterina Vladimirovna, Lefapha la Phekolo

Federal State Budgetary Institution Endocrinology Science Center ea Ministry of Health of Russia E-mail: [email protected] Troshina Ekaterina Anatolyevna MD, moprofesa, hlooho ea lefapha la bongaka le sehlopha sa botena

Federal State Budgetary Institution "Setsi sa Saense sa Endocrinological" sa Lefapha la Bophelo la Russia

Tšebeliso ea bongaka la bariatric bakeng sa lefu la tsoekere la mofuta oa 2: ho thusa ngaka

Ts'ebeliso ea ts'ebetso ea bongaka ea bariatric ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere mellitus (T2DM) e na le litšobotsi tsa eona. Thutong ena, ho bontšitsoe matšoao le litlolo bakeng sa ts'ebetso ea bariatric, ho kenyelletsa le e ikhethang - ka pel'a T2DM. Mefuta e fapa-fapaneng ea ts'ebetso ea bariatric le mekhoa ea phello ea bona ho carbohydrate le lipid metabolism li hlalositsoe. Liphetho tsa ho buuoa ka thibelo le shunt bariatric ho bakuli ba nang le botenya le mofuta oa 2 lefu la tsoekere oa bontšoa. Litlhoko tsa ts'ebetso ea bariatric li hlahisoa 'me likarolo tsa ho lekola ts'ebetso ea tsona li fanoa, ho kenyelletsa tšoarelo ea T2DM kamora ho kena lipakeng tsa bariatric. Lisosa tsa hypoglycemia ea post-bariatric, hammoho le bolepi ba kemiso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso ea ts'ebetso mabapi le taolo ea metabolic ho bakuli ba nang le botenya le T2DM li ea hlahlojoa.

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Mantsoe a bohlokoa

Ho buoa bakariatric (ho tloha baros ea Greek - e boima, e boima, ke e matla) ke ts'ebetso ea ho buoa e etselitsoeng mochini o silang lijo ho theola boima ba 'mele (MT).

Lilemong tse mashome tsa morao tjena, mekhoa ea ho buoa e sebelisitsoe haholo ho potoloha le lefats'e ho phekola botenya haholo, mme ho na le tloaelo e hlakileng ea ho eketsa palo ea ts'ebetso e etsoang le ho atolosa palo ea linaha tseo ho tsona ho buoang batariatric ho ntseng ho ata haholo.

Lipakane tsa kalafo ea ho buuoa ka botenya:

• ka lebaka la ho fokotseha ho hoholo ha MT, ho ama tsela eo maloetse a ntlafalang ka eona ha MT e eketseha (mofuta oa 2 lefu la tsoekere mellitus (T2DM), khatello ea methapo ea mali, lefu la apnea syndrome, ho hlohlona ha ovari, jj.
• ntlafatsa bophelo ba bakuli ba batenya haholo.

Matšoao a ho buuoa ka bariatric

Phekolo ea kalafo ea botena e ka etsoa haeba mehato ea pele e thibelang ho fokotsa MT ho bakuli ba lilemo li 18 ho isa ho 60 ha e sebetse ka:

• ho hloka boima ba 'mele (index ea mmele boima (BMI) ≥40 kg / m2),
• botenya ka BMI ≥35 kg / m2 hammoho le maloetse a tebileng a kopaneng a sa laoloang ke liphetoho tsa mekhoa ea bophelo le kalafo ea lithethefatsi.

Contraindication bakeng sa bongaka ba bariatric ke ho ba teng ha mokhethoa:

• joala, lithethefatsi kapa joala bofe kapa bofe.
• bokuli ba kelello
• exacerbations ea peptic ulcer ea ka mpeng kapa duodenum,
• boimana
• mafu a oncological
• liphetoho tse ke keng tsa fetoloa ka lebaka la litho tsa bohlokoa (pelo e sa foleng ea sekolo sa IV - lihlopha tse sebetsang tsa IV, ho hloleha hoa hepatic kapa renal),
• ho se utloisise likotsi tse amanang le ts'ebetso ea bariatric,
• tlhokeho ea ho latela ts'ebetso e thata ea kemiso ea lits'ebetso tsa postoperative.

Lits'ebetso tse ikhethileng ha u rera ho buuoa ka bariatric ho bakuli ba nang le botenya le lefu la tsoekere ke:

• lefu la tsoekere
• li-antibodies tse molemo ho glutamic acid decarboxylase kapa Langerhans islet cell,
• C-peptide 50 kg / m2), phello ea tsona ha e ts'oarehe. Maemong a tahlehelo ea ts'ebetso e thibelang nakong e telele (mohlala, ka ho pheta-pheta ha suture e emeng, ho fokotseha ha karolo e nyane ea mpa kapa ho senyeha ha bandage), ho na le menyetla ea 'nete ea ho khutlisetsoa ha MT le ho khutlisetsoa ha DM2.

Motheo oa ketso ea malabsorbent (shunting) le ts'ebetso e kopaneng ke ho ts'oaroa ha likarolo tse fapaneng tsa mala a manyane, tse fokotsang ho monya lijo. Nakong ea gastroshunting (GSh, feiga. 2a), boholo ba mpa, duodenum le karolo ea pele ea mala e nyane li emisitsoe tseleng ea lijo, mme ka li-biliopancreatic shunting (BPS, Figs. 2b le 2c), hoo e ka bang jejunum eohle.

Ts'ebetso e kopaneng, ho kopanya likarolo tse thibelang le tse thibang, e tšoauoa ka ho rarahana ho hoholo le kotsi ea litlamorao tse sa rateheng, leha ho le joalo, e fana ka sephetho se boletsoeng haholoanyane le se tsitsitseng sa nako e telele, mme hape se ama hantle ts'ebetso ea mathata a metabolic le mafu a amanang le botenya, a khethang a bona a mantlha menyetla.

Mekhoa ea ts'ebetso ea GSH ho metabolism ea carbohydrate ho botenya le mofuta oa 2 lefu la tsoekere:

• phetoho e qobelloang nakong ea ts'ebetso ea pele ho ts'ebetso ea ho ja lijo tse matla haholo tse tlase-khalori,
• ho qheleloa ka thoko ho duodenum ho kopana le boima ba lijo, e lebisang ho thibelo ea lintho tsa lefu la tsoekere, seo ho thoeng ke li-anti-incretins (bao e ka bang batseteli ke insulinotropic polypeptide (HIP) le glucagon, tse hlahisitsoeng karolong e haufi ea mala e le kannete ho arabela ho kenella ha lijo le lihlahisoa tse hanyetsanang kapa ketso ea insulin
• ho potlakisa ho kenella ha lijo karolong e ka thōko ea mala a manyane, e leng ho thusang ho nts'etsopele ea glucagon-peptide-1 (GLP-1), e nang le "insulinotropic", e tlatsetsang ho seo ho thoeng ke "incretin" e etsahalang ha chyme e fihla Ileum L-cell pele (monyetla) nts'etsopele ea lefu la ho lahla - ponahatso e makatsang ka ho fetisisa ea phello ea "incretin" - e fokotsa monyetla oa hore bakuli ba jang limatlafatsi tse bonolo tse kenang lijong tsa mmele),
• thibelo ea secretion ea glucagon tlasa ts'usumetso ea GLP-1,
• ho potlakisa mokhoa oa ho sebetsa ka botlalo ka lebaka la litlamorao tsa GLP-1 litsing tse tsamaellanang le bokong,
• theoha butle-butle ka boima ba visceral.

BPSh phetolelong ea Scopinaro e bolela ho khutlisetsoa ka mpeng, ho siea palo ea kutu ea mpa ho tloha ho 200 ho isa ho 500 ml, ho tšela ka mpeng e nyane ka bolelele ba 250 cm ho tloha sekhutlong sa ileocecal, sebopeho sa enteroenteroanastomosis - cm 50. bolelele ba loop e tloaelehileng ke 50 cm, le 200 ea phepo e nepahetseng cm (Fig.2b).

Ts'ebetso ea BPSH ea mantlha ho ntlafatseng ea Scopinaro mohoanto o itseng oa bakuli e tsamaisana le nts'etsopele ea ulcers ea ka mpeng, ho tsoa mali, le ho lahla methapo. Ka hona, hajoale e sebelisoa haholo.

Ho HPS ho Hess - Marceau modifying ("Biliopancreatic Diversion with Duodenal switchch", ke ho re, HPS (ho koeteloa) e nang le duodenum e felile, mofets'e oa pyloric o bolokang mofetše oa senya, mme ileum ha e anastomosed ka kutu ea mpa, empa ka karolo ea pele ea duodenum. Bolelele ba mala a nkang karolo ea lijo bo ka ba 310-350 cm, eo cm cm 80-100 e abeloang ho loop e tloaelehileng, cm-2-2250 ho ea alimentary (sa feiga. 2c). Melemo ea ts'ebetso ena e kenyelletsa ho bolokoa ha pylorus le phokotso ea menyetla ea ho nts'etsopele ea ho lahla lintho ka mpeng le li-peptic ulcers sebakeng sa duodenoelanastomosis ka lebaka la sena, e leng se bakang ho fokotseha ho hoholo ha palo ea lisele tsa parietal nakong ea mofetše oa senya.

Ntle le mekhoa e hlalositsoeng ea ho susumetsa litekanyetso tsa metabolic ho botenya le T2DM maemong a BPS, ho na le:

• ho khetha malabsorption ea mafura le lik'habohaedreite tse rarahaneng ka lebaka la ho kenella ka nako ea enzyme ea pancreatic le pancreatic ka har'a tšilo ea lijo, e leng se etsang hore ho fokotsehe ha palo ea mafura a mahala tsamaisong ea methapo ea methapo, 'me ka lebaka leo, ho fokotseha ha insulin, ke eona ntho ea bohlokoahali e khethang ntlafatso ea thupelo ea T2DM,
• phokotso e khethiloeng ea ho hlahisa sebopeho sa ectopic lipid mesifeng le mokokotlong, e ntlafatsang kutloisiso ea insulin (kaha ho imeloa ke sebete haholo ka lipid ka ho nona ho amana le bokhoni bo fokolang ba litheko tsa adipose tsa ho bokella lipids le ho phahamisa molumo, e leng se lebisang ho emeng ha ectopic ea mafura le lipotoxicity, ho theha motheo oa dyslipidemia le ho hanyetsa insulin ho T2DM).

Phihlelo ea ho sebelisa bongaka la bariatric ho bakuli ba batenya hammoho le mafu a metabolic le mafu a ile a lumella Buchwald H. le Varco R. morao ka 1978 ho theha mohopolo oa "ts'ebetso" ea "metabolic" e le karolo ea ts'ebetso ea bongaka e sebetsanang le "ts'ebetso ea ts'ebetso ea setho kapa tloaelo e le hore e fihlelle likokoana-hloko. sephetho sa ntlafatso ea bophelo bo botle. ”Nakong e tlang, tloaelo ea nako e telele ea ho sebelisa lingaka tsa bariatric ho bakuli ba nang le botenya le eona e amanang le eona T2DM, sepheo seo qalong se neng se fokolisa MT, se bonts'itse menyetla e meholo ea ho buuoa ho fihlela puseletso bakeng sa T2DM, e nts'etsopele khahlanong le semelo sa botena.

Haufinyane, litumelo le li-stereotypes tse mabapi le T2DM ho bakuli ba batenya li boetse li hlahlojoa. Ka ho khetheha, polelo ea hore tahlehelo e kholo ea MT ke ntho e khethollang ho ntlafatsa taolo ea glycemic ho T2DM, e tsoetseng pele khahlanong le semelo sa botena kamora ho buuoa ka bariatric, e ile ea hlakisoa ke taba ea hore phokotso ea glycemia e hlokometsoe ho tloha libeke tsa pele kamora ho buoa, i.e. nako e telele pele ho fokotseha ho hoholo ha MT. Ka kamohelo e atileng ea mefuta e rarahaneng ea ts'ebetso ea bongaka ea bariatric (GSH, BPSH) ts'ebetsong, ho ile ha totobala hore ho fokotseha ha MT ke ntho e le 'ngoe, empa eseng eona feela ntho e khethollang ntlafatso e boletsoeng esale pele ea metabolism ea carbohydrate ho batho ba batenya ba nang le T2DM.

Katleho ea ts'ebetso ea bongaka ea bariatric bakeng sa lefu la tsoekere la mofuta oa 2

Kaha kalafo ea T2DM e kenyelletsa taolo ea eseng feela taolong ea glycemic, empa le lintlha tsa kotsi ea pelo, ho buuoa ka bariatric ho ka khothaletsoa ho bakuli ba nang le botenya le T2DM ba sa fihlelleng lipheo tsa kalafo ka kalafo ea lithethefatsi, joalo ka ba ntlafatsa haholo mokhoa oa khatello ea methapo ea methapo, dyslipidemia, thibelo ea ho koaleha moea ka nakoana ka boroko, joalo-joalo, ho ekelletsa moo, ba fokotsa sekhahla se bolaeang sa lefu.

Ts'ebetso e thibelang e kenya letsoho pusong ea T2DM: ntlafatso ea metabolism ea carbohydrate libekeng tsa pele kamora ho buuoa ka lebaka la phetisetso ea bakuli lijong tsa ultra-low-calorie, 'me hamorao, ha depositi ea mafura e fokotseha, ho qaleha ha matšeliso a T2DM ho ka etsahala, empa tekanyo ea ona e lekana le palo ea tahlehelo ea MT, ho fapana le ts'ebetso e fokolang. kamora moo ho tloaelehileng ha glycemia e iponahatsang le pele ho fokotseho e kholo ea MT ka lebaka la seo ho thoeng ke "incretin athari."

Tlhahlobisong ea hae ea meta, Buchwald H. et al. e hlahisitse litholoana tsa lithuto tsohle tse phatlalalitsoeng mabapi le ho buuoa ka bariatric ho tloha ka 1990 ho fihlela 2006. Phello ea katleho ea bona ho metabolism ea carbohydrate ho bakuli ba nang le botenya le T2DM e ile ea hlahlojoa ke karolo ea bakuli ba nang le maemo a tloaelehileng kapa ntlafatso ea lipontšo tsa kliniki le tsa laboratori tsa T2DM (lithuto tsa 621 tse kenyelletsang bakuli ba 135,246 li kenyelelitsoe tlhahlobisong ea meta-(meta1, 2).

Lethathamo la 1. Litlamorao tsa mefuta e fapaneng ea ho buuoa ka bariatric ka tahlehelo ea MT le thupelo ea T2DM ea bongaka