肥胖合并2型糖尿病外科治疗研究进展

Advance in surgial treatment of obesity complicated with type2 Diabetes mellitus

作为肥胖合并2型糖尿病的有效治疗方式,减重手术经过近些年的发展和演变,目前流行的术式已是多种多样,如腹腔镜袖状胃切除术、腹腔镜下胃旁路术、单吻合口胃旁路术、各种以胃袖状切除术为基础的复合手术,以及新近兴起的胃肠转流支架等,这些术式都有自己的优势和不足。本文就多用于治疗肥胖合并2型糖尿病的常见减重手术术式进行分析,结合本中心的实践经验,总结出各种术式的自身特点。整体而言,在各种术式的演进过程中,维持长效的、显著的减重降糖效果,同时尽可能减少营养性并发症的发生率贯穿始终的挑战。如何更好地应对这种挑战不仅是术式发展的核心问题,也是衡量创新水平的重要标志。因此,根据实际情况个体化地为患者选择最佳术式,帮助患者获得最高的风险收益比,是未来减重外科发展的必由之路。

As an effective treatment for obesity complicated with diabetes mellitus type 2,bariatric surgery has been developing and evolving in recent years,resulting in various popular surgical methods,such as laparoscopic sleeve gastrectomy,laparoscopic Roux-en-Y gastric bypass,one anastomosis gastric bypass,various hybrid operations based on LSG,newly emerging gastrointestinal bypass stent implantation and so on,each with their respective advantages and disadvantages.This article aims to review the common bariatric surgery procedures for the treatment of obesity combined with diabetes mellitus type 2,and to summarize the characteristics of each one basing on the practical experience of our center.During the evolution of each procedure,it has always been a challenge to achieve a perfect combination of lasting and definite weight losing and blood sugar lowering effect with a very low risk of nutritional complications.How to better deal with this challenge is not only the core issue of the development of bariatric surgery,but also an important measurement of innovation.Thus,it is the only way for future development to choose the best surgical method for patients individually according to actual conditions,and therefore help them obtain the highest risk-benefit ratio.