[1]Rubino Francesco　 Gagner Michel①　 李金明②,朱江帆②.胃转流手术治疗2型糖尿病的可行性[J].中国微创外科杂志,2004,04(1):8-11.
　Rubino Francesco*,Gagner Michel.Potential of surgeny for curing type 2 diabetes mellitus[J].Chinese Journal of Minimally Invasive Surgery,2004,04(1):8-11.
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胃转流手术治疗2型糖尿病的可行性()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
04
期数:
2004年1期
页码:
8-11
栏目:
国外医学动态
出版日期:
2004-01-20

文章信息/Info

Title:
Potential of surgeny for curing type 2 diabetes mellitus
作者:
Rubino Francesco　 Gagner Michel①　 李金明②; 朱江帆②
IRCAD-European Institute of Telesurgey,Strasbourg,France stuasbourg,67091
Author(s):
Rubino Francesco*;  Gagner Michel
IRCAD-European Institute of Telesurgery,Strasbourg67091,France
关键词:
糖尿病;  肥胖症;  胃转流;  胆胰转流
Keywords:
Diabetes; 　Obesity; 　Gastric bypass; 　Biliopancreatic diversion
分类号:
R656.6+1
文献标志码:
A
摘要:
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.
Abstract:
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.　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 biliopan- creatic 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 under- going biliopancreatic diversion for other indications.　Conclusions　Gastric bypass and biliopancreatic diversion seem to achieve con- trol 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.

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备注/Memo

备注/Memo:
①（纽约西奈山医院微创外科中心 纽约 10021）②（上海复旦大学附属金山医院普外一科 上海 200540）
更新日期/Last Update: 2014-05-14