内科与外科的交锋:代谢手术的未来

Battle between internal medicine and surgery bariatric surgery in the future

尽管越来越多的证据表明,代谢手术能够显著改善2型糖尿病预后,但现有糖尿病的标准治疗方案并不包括手术选项。随着对其作用机制的不断探索和大量临床证据的积累,越来越多的内、外科医生接受和认可了手术的疗效与安全性。2016年最新一项指南发布宣告了近百年来2型糖尿病治疗方案的巨大变革,至文章发表,指南已得到45个国际组织的官方支持和认可。新指南基于多项临床研究结果,提出将胃肠道手术作为合适患者的标准治疗选择之一。但与此同时,代谢手术的实施需要内外科相辅相成、互相弥补才会使患者获得最大收益。代谢减重外科自进入中国以来在发现与解决问题的过程得到迅猛发展,代谢外科医生在这一充满机遇与挑战的领域里积累了宝贵的经验。尽管当前存在着一定的局限性,但代谢外科无疑有着光明的临床发展前景与重大的科学研究价值。

Despite growing evidence that bariatric/metabolic surgery powerfully improves the prognosis of type 2 diabetes（T2DM）, existing diabetes treatment algorithms do not include surgical options. With the continuous exploration of its mechanism and the accumulation of a large number of clinical evidence, more and more doctor accepted and approved its efficacy and safety. A clinical guideline published recently announced most radical change in the treatment of type 2 diabetes in a cent. The new guidelines had been endorsed by 45 professional societies around the world, which proposes that surgery involving the manipulation of the stomach or intestine be considered as a standard treatment option for appropriate candidates. But at the same time, the practice of metabolic surgery requires internal medicine and surgery to cooperate with each other to achieve the best effect. Since the bariatric/metabolic surgery was introduced to China, it has developed rapidly in the process of discovering and solving problems. Metabolic surgeons have accumulated valuable experience in this field which is full of opportunities and challenges. Although there are some limitations currently, there is no doubt that bariatric/metabolic surgery have good clinical development prospects and significant scientific research value.