Kwiminyaka emininzi edlulileyo, siye sazuza kwiintuthuko ezingakaze zenzeke ekuqondeni kwethu isifo sikashukela , ukubeka iliso , ukuphathwa kunye nokunyangwa . Ezi nkqubela ziquka ukuqonda okungcono kweengxaki ezincinci kunye nezikhulu zesifo-"i-microvascular" ibhekisela kwimithambo encinci yegazi kunye ne "macrovascular" ibhekisele kwimithambo emikhulu yegazi, njengaleyo efunyenwe entliziyweni nasengqondweni-kunye nokuqhubekayo (" ngongqiqo ") ukubeka i-glucose kunye neklasi entsha yesifo sikashukela: i-sodium-glucose cotransporter 2 (SGLT2) inhibitors njenge-Invokana.
Nangona kunjalo, zonke ezi ntlupheko zithetha okuncinci kubantu abaninzi abanesifo sikashukela. Nangona unyango olungcono kunye nolawulo, abangaphantsi kwama-50 ekhulwini abo abanesifo sikashukela se-type 2 bafumana ukulawulwa kweeshukela okwaneleyo kwaye bangasengozini yesifo sikashukela, kunye ne-80 ekhulwini yabantu abanesifo seswekile abanesifo sengqondo senhliziyo.
Kususela ekupheleni kweminyaka yama-1980, abaphandi kunye neekliniki baye baqaphela ukuba abantu abaninzi abanesifo sokutya ngokweqile kunye nesifo sikashukela, okanye abantu abanesifo sikashukela, abafumana i-metabolic, okanye i-bariatric, amava okwenziwa ngophezulu aqhubeka nokuphucula ukulawulwa kwe-glycemic kunye nokunciphisa ingozi yomzimba. Ukongeza koko, abanye abantu abafumana ukuhlinzwa ngokugqithisileyo bafumana ukuxolelwa ngokukhawuleza kwaye akusafuneki ukuthatha nayiphina imithi! Nangona kunjalo, nangona le ngqalelo, iingcali ziye zanqwenela ukucebisa iingcebiso zesikhokelo sonyango malunga nendawo yokuhlinzwa ekunyangeni uhlobo lwesifo sikashukela ... okokuba, ukugqitywa kweSifo seSifo seSifo sikashukela (DSS-II) ngoSeptemba 2015 .
Ingqalelo, nangona isetyenziswe ngokungafaniyo, utyando lwe-bariatric lubhekisela ekusebenziseni ukunyuka kwesisindo, kodwa ukuhlinzwa ngokucwangcisa umzimba kubhekisele ekusebenziseni ukuphucula isifo sikashukela kunye nesifo segazi.
Kwi-DSS-II, iingcali ezivela kwihlabathi lonke ngokubambisana kunye neenkampani zonyango ezi-45 ezihamba phambili, kubandakanywa nemibutho ehamba phambili yesifo sikashukela: i-American Diabetes Association, i-International Diabetes Federation, iSetydabes Society Society, i-European Association for the Study of Diabetes Diabetes India, kunye Isifo sikashukela sase-UK, sihlolisise bonke ubungqina obukhoyo kwaye senza iingcebiso zomhlaba jikelele ngokuphathelele ukudibanisa unyango lwezonyango kunye nophatho lwe-diabetes.
Banikezela ngesikhokelo esinokufunwa kakhulu malunga nokukhethwa kwabaviwa abagqirha kunye kunye neziphakamiso zokulandelelana kwangaphambili nangemva kokulandela.
Iintlobo zeeNtsholongwane zokuTyhila
Utyando-ukulahlekelwa kwemithwalo-mpahla lufumene uninzi lwe-press kule minyaka. Ngaloo ndlela mhlawumbi unomqondo othile wendlela ezinye zeenkqubo ezibandakanya ngayo. Nangona kunjalo, masenze ukuhlaziywa ngokukhawuleza kwezona ziindidi ezine eziphambili zokuhlinzwa.
- I-Roux-en-Y isantya sokutya . Le nkqubo yinkqubo ye-bariatric eqhelekileyo eyenziwa kwihlabathi lonke. Olu uphando luqhutyelwa i-laparoscopically, okanye ngeendlela ezincinci ezingenayo, kwaye ziphumo ekulahlekeleni ubunzima obukhulu kunye nophuculo lwesifo sikashukela. I-roux-en-Y isantya sesantya siquka ukudala isikhwama sesisu esisuka kwisahlulo sesisu size sibambe esi sikhwama esincinci ngqo emathunjini ngaloo ndlela sidlulisele ukugubha okukhulu kwesisu kunye namathumbu. kwindawo yomhlaba kwaye kubangele ukuxhamla kwangaphambili, okanye ukuvakalelwa kwento epheleleyo, kodwa nokunciphisa ngokukhawuleza ukunyuswa kwamafutha. Ingqalelo, iinkqubo ze-bariatric ezitshintsha ubukhulu besisu zibizwa ngokuba ngumqobo; nangona, ezo zigulo kunye nomathumbu kunye nokutshintshwa kwegazi zibizwa ngokuba yi-malabsorptive. Amaphesenti angaba ngu-75 abantu abanesifo sikashukela abawela kwinkqubo ye- roux-en-Y yesantya iya kubakho ukuxolelwa. Ukongezelela, ngaphezu kweepesenti ezingama-90 zezi zi gulane ziya kuphucula izilwanyana kwezinye izilwanyana zesifo se-metabolic, kuquka ukunciphisa i-lipid (i-cholesterol kunye ne-triglyceride). Ukuqhawula, abantu abafumana olu lungiso banokuthi banqunywe ukupheliswa kweGERD (ukuguquka kwentliziyo) kunye nokuphuculwa kwentlungu edibeneyo, ukuxinezeleka, imiba yokungabikho komntwana, ukungabikho kokunyamezela, ukuzithemba kunye nomgangatho wobomi bonke.
- I-laparoscopic sleeve gastrectomy : Le nkqubo intsha iyanda kakhulu kwi-United States. Ngethuba le nkqubo, oogqirha basusa phakathi kwe-75 ne-80 ekhulwini yeesisu xa beshiya amanye amaninzi. Ekuqaleni, iingcali zazicinga ukuba le nkqubo yayimqobo nje; Nangona kunjalo, uphando lwangoku lubonisa ukuba le nkqubo inyukisayo ukukhululwa kwama-incretin okanye amahomoni okukhuthaza ukukhululwa kwe-insulini ngamaphakethi. Nangona uphando olungakumbi lufuneka luyenze uphando malunga neenzuzo ze-sleeve gastrectomy, kubonakala ngathi i-sleeve gastrectomy ifaniswa ne-roux-en-Y isisu esiswini ngokugqithiseleyo ukulahleka kwesisindo kunye nemiphumo emibi, kunye neerhafu ezifanayo zesifo sikashukela kunye nokunciphisa i-diabetes complications kunye nemingcipheko.
- Inkqubo ye-Laparoscopic yokulungiswa ngokufanelekileyo : Inqubo yebhanti yegastric band iquka ukubeka ibhinqa ejikeleze isahlulo esiphezulu sesisu ukuze wenze isikhwama esincinci siphumelele okokuqala. Ngenxa yokuba i-band gastric band iyingenelo encinci kunezinye iindidi ze-gastrectomy kunye neRoux-en-Y-ithatha ixesha elide ukuze kubangele ukulahleka kwesisindo nokuphuculwa kwesifo sikashukela. Nangona kunjalo, phakathi kwama-50 no-80 ekhulwini abantu abafumana le nkqubo bafumana ukuxolelwa kwesifo sikashukela. Ukongeza koko, abantu abafumana le nkqubo bafumana ukuhla kwezinga leepidid, nangona kuncinci kuncinci kubonwe emva kwezinye iintlobo zokuhlinzwa.
- I-Biliopancreatic diversion kunye ne-duodenal switch (BPD / DS) : Ngaphandle kokungena kwi-nitty-gritty, nceda ukhumbule ukuba, njengokuba kunokwenzeka ukuba yenziwe ngegama layo, i-BPD / DS yinkqubo eyinkimbinkimbi ebandakanya amaninzi okulungiswa kwamanzi. Olu hlobo lotyando luyabambisa kwaye lukhuselekile kwaye lujoliswe kubantu abakhulu kakhulu (bacinge nge-BMI ngaphezu kwama-50). Okubaluleke kakhulu, i-BPD / DS iphumela kwizikhulu ezinkulu kunye nezona zizinzileyo zokulahlekelwa kwesisindo phakathi kwazo zonke iindlela zokuhlinzwa kunye nokuphucula okukhulu kwi-diabetes kunye neepidal profiles. Enyanisweni, uphando oluthile luye lwabonisa ukuba phantse iipesenti eziyi-100 zabantu abafumana le nkqubo bafumana ukuxolelwa kwe-diabetes! Ngaphezu koko, i-BPD / DS ibonakala ngokuphucula kakhulu i-apnea yokulala phakathi kwezigulane ezitholayo. Nangona kunjalo ngenxa yobume bayo obukhulu-ukulungiswa kwakhona nokunqanda umgudu kubangele ukuba kubangelwe imiphumo emibi-abantu abafumana le nkqubo bafumana umngcipheko ophezulu wokunqongophala kwezondlo, ezinye zazo ezingenakuqondwa ngokupheleleyo kwaye zingasongela ubomi.
Ngo-2013, uqikelelo olwenziweyo lwangama-179,000 olwenziwe ngophupha. Nantsi ukuphazamiseka:
- Iipesenti ezingama-42 zaziyi-sleeve gastrectomy
- Amaphesenti angama-34 ayedla
- Iipesenti ezili-14 zaziyi-band gastric band band
- Iipesenti ezi-1 zaziyi-BPD / DS
- Iipesenti ezi-6 zahlaziywa
Ingozi
Ngokubanzi, utyando olusondeza umzimba lukhuselekile, ngakumbi xa lwenziwa ngumgqirha onogqirha ongugulane olungiselele inkqubo kwaye uzibophelele ekuphumeleleni kwenkqubo. Nangona kunjalo, njengazo zonke iindlela zokuhlinzwa, izinto ezimbi zenzeke emva kokuhlinzwa okwenzisayo. Ngaloo ndlela, ukuhlinzwa ngokugqithisileyo kusacingwa ngonyango lwe-line kunye nokugcinwa kwabantu abangaphumeleli unyango ngokutya, ukuzivocavoca kunye namayeza.
Nazi ezinye iimpembelelo ezichaphazelekayo ezinxulumene nophenyo olumandla. Nceda uqaphele ukuba le miphumo emibi iyahluka kuye kuxhomekeke kwinkqubo ethile eyenziweyo. Ngokomzekelo, uRoux-en-Y kunye ne-BPD / DS ziyi-invasive kwaye zingabangela ezininzi zeziphumo ezibi; nangona, i-lapast band band ibangela iziphumo ezimbi kakhulu ezingahambelani namathumbu.
- Ukunqongophala kwemethambo kunye nezondlo
- Ulcers
- Isalathiso sokusabalalisa isantya ekhokelela kwi-ileus (isithintelo esiswini)
- I-Cholelithiasis (iigolstones)
- I-Hernia kwindawo yesicatshulwa
- I-Adhesions (iindawo ezinamathele ezithintelayo kwaye zivimbele isilonda)
- Isifo sokulahla
- Ukuhluleka kweengso
- Sulelo
- Stenosis
- Ukuguguleka kwamanqanaba (kunye ne-band band)
- Tshintsha kwimikhwa yobomi
- Reflux
Olu luhlu alukho olupheleleyo okanye olukhethekileyo naluphi na uhlobo oluthile lotyando oluthile. Nceda ucinge ngenyameko uphando olungabonakaliyo lwendlela yokuhlinzwa phambi kokuba wenze nayiphi na inkqubo enjalo. Ukongezelela, xubusha le miphumo emibi ngokucacileyo kunye nodokotela wakho ogqirha kunye neqela lezempilo. Utyando lwe-metabolic ayikho i-panacea eya kuphilisa zonke izifo zakho ngaphandle kwesizathu. Kunoko, isisombululo esifanelekileyo sokuphucula impilo yakho.
Ziziphi Izigulane Zesifo Sikashukela Ngaba Ngaba Abaviwa Bakagqirha?
Njengoko kukhankanywe ngaphambili, ngokokuqala ngqungquthela kwi-DSS-II yaphakamisa i-algorithm yonyango yokunyanga kwesifo sikashukela ngokusebenzisa utyando. Okugqithiseleyo, iingcali zincoma ukuba utyando lubonwa ngabantu abaphela kakhulu (i-BMI phakathi kwe-30 no-34.9) nesifo sikashukela esingalawulwa ngenye imithi yomlomo okanye i-insulin.
Nazi ezinye iingcebiso zonyango kubantu abano-diabesity:
- Ugqirha lwe-metabolic kufuneka lunconywe kwizigulane ezinobunzima beklasi III (i-BMI ngaphezu kwama-40) abahlala bengalawulwa ngokusetyenziswa kweenguqu zokutya (ukutya nokuzilolonga) kunye nokuphathwa kwezonyango (imithi yomlomo kunye ne-insulin).
- Ngokufanayo, ukutyunjwa kwamagciwane kufuneka kunconywe kwizigulane ezinobunzima beklasi II (i-BMI phakathi kwe-35 no-35.9) abahlala bengalawulwa ngaphandle kokuguqulwa kwendlela yokuphila kunye nolawulo lwempilo.
- Njengoko kuchaziwe ngasentla, ukuhlinzwa ngokugqithiseleyo kufuneka kuthathelwe ingqalelo kubantu abagqithiseleyo (i-BMI phakathi kwe-30 no-34.9) kwaye abakwazi ukuphumeza ukulawula isifo sikashukela nangona utshintsho ekudleni nasekusebenzeni kunye nokuphathwa kwezonyango ngemithi yomlomo kunye ne-insulin.
Iingcali zincoma nokuba le miqobo kunye nokunqunyulwa kwee-cut-offs zihlengahlengiswe kubantu base-Asia. Kufuneka kuqatshelwe ukuba nangona izibonakaliso zonyango lwe-diabesity usebenzisa utyando kunye nesixa sobunzima esilahlekileyo ngabantu abavela kwiintlanga ezahlukeneyo zingahluke, ukuphuculwa ngokwenene kwesifo sikashukela kunye neerhafu zokuxolelwa emva kokuhlinzwa kuqhathaniswa kuzo zonke iintlanga. Ngamanye amazwi, ukuhlinzwa ngokufanayo kunceda abantu bazo zonke iintlanga ngokubhekiselele ekuphuculweni kwesifo sikashukela nokuxolelwa kwezifo.
Kwinqaku echaphazelekayo, kuba uhlobo lwesi-2 lwesifo sikashukela alusayi kuthathwa nje ngokuba "luqala abantu abadala" kwaye luchaphazela inani elinyukayo kwaye elinoyikisayo labantwana nabaselula, iingcali zincoma ukuba uphando olongezelelweyo luqhutyelwe ukucacisa indima yokuhlinzwa ngokuchanekileyo kunyango lwabantwana yeswekile. Ukongezelela, iingcali zincoma kwakhona uphando olongezelelweyo malunga nokuba utyando lunokubanceda kakhulu abantu abanomdla wesifo sikashukela. Ngokukodwa, kubantu abanesifo sikashukela se-type 1, utyando lwe-bariatric lunokwenza lula ukulawulwa kwe-glycemic kunye nokunciphisa iimfuno ze-insulin kwakunye nomngcipheko oncitshiswayo wesifo senhliziyo.
Ngaba Unokuphelelwa Kwenyuka Ngendlela Enobulunga Ngayo Ukuphatha I-Diabesity?
Iindlela ezenziwa ngayo utyando olusisigxina okanye utyando lwe-diabesity luyinkimbinkimbi kwaye lunxulumene. Ngokuqinisekileyo, ukuphuculwa okanye ukuxolelwa kwesifo sikashukela esivela kulolu hlobo lotyando kuninzi enokuyenza ngokukhawulelana nekhalori kunye nokulahleka kwesisindo. Nangona kunjalo, kunokwenzeka ezinye iimeko ezininzi ezibangela unyango lwe-diabesity kubandakanya oku kulandelayo:
- Iinguqu kwi- bile acid metabolism
- Iphepha le-GI ukuva nokusetyenziswa kweglucose
- Ukukhululwa kwe-Incretin (khumbula ukuba ii-incretins zikhuthaza ukukhululwa kwe-insulini ngamaphakethi)
- Inxaxheba ekhoyo yokulwa ne-incretins
- Utshintsho kwi- flora (ukubunjwa kweebhaktheriya ezihlala emanzini)
Oku kunokwenzeka ukuba, le miphumo kunye nabanye esingazange sisebenzise ukuxilana ngokubangela ukuba kuphuculwe isifo sikashukela kunye nokuxolelwa emva kokuhlinzwa. Ukongezelela, ezinye zezi ndlela zixhomekeke kuhlobo lotyando olwenziwa.
ILizwi
Ukuba wena okanye umntu obathandayo unesifo sikashukela esingalawulwa ngumdla, umzimba, kunye namayeza, unokufuna ukuxoxa ngezibonelelo zokuhlinzwa ngokugqithisa kunye nodokotela wakho. Nangona utyando olunjalo aluzange lusetyenziswe unyango lokuqala, utyando olunjalo lunokunceda ukuba ugweme iingxaki zesifo sikashukela kunye nokuhlupheka.
Ngenxa yokuba amanyathelo anqamlekileyo kwaye angenakuvuthwa awanakho ukuphatha isifo sikashukela, oko akuthethi ukuba imeko yakho ayikho ithemba okanye umgangatho wobomi awuyi kuphucula. Nceda ugcine ukhumbule ukuba utyando lwenkqubo yinkqubo ekhuselekileyo ekhuselekileyo eneenzuzo ezininzi zempilo kubandakanywa unyango lwe-type 2 yeswekile. Kwakhona qaphela, nangona kunjalo, ukuba utyando oluthile luyinkqubo efuna ukulungiselela, ukucinga, ukukhuthaza nokuzibophelela. Utyando olunjalo aluzange lulungiswe ngokukhawuleza okanye olulula kwaye lufuna ixesha lokuphila lokulondolozwa kwezempilo kunye nokwenza izigqibo ezicacileyo.
Ukuba unemibuzo malunga novavanyo lwe-diabesity okanye ukunyuka kwe-weight loss, yenza isiganeko kunye nodokotela wakho ukuba uxoxe ngezinto ozikhathazayo kunye nezinto ozikhethayo.
Imithombo:
Batterham RL noCummings DE. Iinkqubo zokuphucula isifo sikashukela Ukulandela u-Bariatric / Utyando lweMetabolic. Uncedo lweSwekile 2016 Juni; 39 (6): 861-877.
I-Cefalu WT, uRubino F kunye neCummings DE. Ugqirha lweMetrilic for Type 2 Diabetes: Ukutshintsha indawo yeSifo sikashukela. Uncedo lweSwekile 2016 Juni; 39 (6): 857-860.
U-Ellsmere JC, u-Jones D no-Chen W. iingxaki ezinokuthi zenziwe ngophando lwe-bariatric. UpToDate 2016.
Rubino F, uNathan DM, uEckel RH, et al. Ugqirha lweMetabolic kwi-Algorithm yeTransm for Type 2 Diabetes: INgxelo edibeneyo yeZizwe zamaZwe eSizwe ngamazwe. Uncedo lweSwekile 2016 Juni; 39 (6): 861-877.
Schauer PR, uSchirmer B. Ulawulo oluPhezulu lokuPhalala. Ku: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. I-Schwartz Iimigaqo zoPhando, 10e . New York, NY: McGraw-Hill; 2014.