减重手术治疗肥胖型2型糖尿病热点问题

Hot issues about treatment with bariatric surgery for obesity/type 2 diabetes mellitus

肥胖型2型糖尿病(T2DM)患者人数与日俱增,内科治疗常常疗效不佳。减重手术治疗此类患者的疗效优于传统内科治疗,可有效控制内科治疗无法控制病情的肥胖型T2DM患者。近年研究热点聚焦在改良手术方式、更新手术指征、探索治疗机制。临床上对患者是否施行减重手术,需综合考虑年龄、体重指数、胰岛储备功能、术后能否改变生活方式等诸多因素,根据患者个体情况选择最佳术式以达到满意疗效。规范外科操作、密切随访、积极预防、早期处理可有效改善术后并发症。术后体重反弹及糖尿病复发不容忽视,需积极探索机制、寻找预测因素及规范处理方法,正规、长期的随访是使患者维持术后疗效和安全的关键。

The patients with obesity/type 2 diabetes mellitus become more and more, but the efficacy of internal medical therapyis not very good. The effect ofbariatric surgery for these patients is superior to that of traditional internal medical therapy, and it can effectively control the obesity/type 2 diabetes mellitus in patients who have no response to internal medical therapy： In recent years, the hot spots of research focus on improving operation methods, updating surgical indications and exploring therapeutic mechanism. Concerning the application ofbariatric surgery to patients in clinical practice, we should take these factors into consideration including age, body mass index, the reserve function of pancreas islet, changing life style after operation and so on. The optimal surgical method should be chosen according to individual situation of the patients in order to achieve the satisfactory effects.There are several approaches which can improve postoperative complications effectively, including standard surgical operation, frequent follow-up, active prevention and early management. It should not be neglected that bodyweight rebound after surgery and diabetes mellitus recurrence may appear, so it is necessary to explore mechanism actively , seek predictive factor and standardize handling approaches. Standard follow-up for a long time is the key step to maintain curative effect and safety of patients after surgery.