Mumakore akawanda akapfuura, takabatsirwa nekufambira mberi kusina kumboitika pakunzwisisa kwedu chirwere cheshuga , kutarisa , kutarisira , nekurapa . Kufambira mberi uku kunosanganisira kunzwisisa zviri nani nezve microvascular uye macrovascular complications zvechirwere ichi- "microvascular" inoreva mito miduku yeropa uye "macrovascular" inoreva mishonga yakanyanya yeropa, yakadai seyo inowanikwa mumoyo uye muuropi-pamwe nekuenderera mberi (" akachenjera ") glucose kutarisa uye kunyange kechipiri chechirwere cheshuga zvinodhaka: sodium-glucose cotransporter 2 (SGLT2) inhibitors dzakadai seChitokana.
Zvisinei, kufambira mberi uku kwose kunoreva zvishoma kuvanhu vazhinji vane chirwere cheshuga. Pasinei nokurapa kwakanaka uye kutungamirirwa, vashoma kupfuura 50 muzana yevaya vane chirwere cheshuga chechipiri vane hutano hwakakwana hwehuga uye vanogona kunge vari pangozi yehutano hwechirwere cheshuga, uye kutyora 80 muzana yevanhu vane chirwere cheshuga 2 chinokonzerwa nehutano hwemwoyo.
Kubvira kuma1980, vatsvakurudzi nevarapiki vakacherechedza kuti vanhu vazhinji vane hutano hwakanyanya uye vane chirwere cheshuga, kana vanhu vane chirwere cheshuga, vanogashira mishonga, kana bariatric, ruzivo rwekuvhiya rwakaramba huri nani mukugadzirisa zvirwere uye kuderera kwehutano hwemwoyo. Uyezve, vamwe vanhu vanogashira chirwere chemagetsi vanoona kuregererwa kwepamusoro uye havachadi kutora chero mishonga! Kunyange zvakadaro, pasinei nekucherechedza kwezvinhu izvi, nyanzvi dzanga dzisingadi kurumbidza kubvumirana kwechirongwa chechirongwa chekurapa maererano nezvenzvimbo yekuvhiyiwa mukurapa rudzi rwechipiri chirwere cheshuga ... izvo, kusvika pakupera kweSaetetes Surgery Summit (DSS-II) munaSeptember 2015 .
Nhoroondo, kunyange zvazvo inowanzoshandiswa zvakasiyana, chirongwa chebhaatric chinongoreva kushanda-kurasikirwa, asi, kuvhiyiwa kwemagetsi kunoreva kuvhiyiwa kunoitwa kuti uwedzere chirwere cheshuga uye zvirwere zvemagetsi.
PaDSS-II, nyanzvi dzinobva kune dzimwe nyika yose pamwe nekubatana nemapoka ekurapa makumi mashanu nematanhatu, kusanganisira shanhatu dzinotungamirira chirwere cheshuga: American Diabetes Association, International Diabetes Federation, Chinese Diabetes Society, European Association for the Study of Diabetes Diabetes India, uye Chirwere cheshuga UK, yakarongedza uchapupu hwose huripo uye yakaita shanduko yepasi rose inoshandiswa maererano nekubatanidzwa kwekurapwa nekurapa mukurapwa kwechirwere cheshuga.
Vakapawo nhungamiro yaidiwa zvikuru pamusoro pekusarudzwa kwevadzidzi vakagadzirwa uye zvose zviri mberi uye shure kwemashure mazano ekutevera.
Mhando dzeMetabolic Surgery
Kurasikirwa-kurasikirwa kurasikirwa kwakagamuchira hurukuro yakawanda mumakore. Nokudaro iwe unogona kunge une imwe pfungwa yekuti mamwe emitemo iyi inosanganisirei. Kunyange zvakadaro, ngationei kukurumidza kuvhara zvinyorwa zvina zvikuru zvekuvhiya kwemagetsi.
- Roux-en-Y gastric inopass . Iyi nzira ndiyo inonyanya kufarirwa yeBaratric yakaitwa munyika yose. Izvozvi kuvhiyiwa kunoitwa laparoscopically, kana nenzira shoma inoparadza, uye inoguma mukurasikirwa kukuru kwekurema nekuvandudzwa kwechirwere cheshuga. Roux-en-Y gastric inpass inosanganisira kusika chikwama chemuviri kubva kune chikamu chemuviri uye zvino kuvhara chikwama chiduku zvakananga mumatumbo kuitira kuti kupfurikidza kuputika kukuru kwemudumbu uye mumatumbo. Kusanganiswa kwekupindira uku hakungori kuderedza dumbu chete nzvimbo yepamusoro uye inoita kuti satiety yapfuura, kana kuti manzwiro ekuzara, asiwo kuderedza zvakanyanya kufungisa mafuta. Nenzira, maitiro e-bariatric anoshandura ukuru hwemucheche anonzi kudzivirira; asi, izvo zvinoputika nemukumbo uye zvinoshandura kunyorera zvinonzi malabsorptive. Vanopfuura 75 muzana yevanhu vane chirwere cheshuga vanoenda mu Roux-en-Y gastric inpass process vachawana kuregererwa. Uyezve, vanopfuura 90 muzana yevarwere ava vachawana humwe humwe hutano hwehutachiona hwehutachiona, hunosanganisira kuderera muhuipi (cholesterol uye triglyceride). Kuti vanhu vawane chirwere ichi, vanotaura kuti kuguma kweGERD (kuora mwoyo) pamwe nekuvandudzwa kwemarwadzo akabatana, kushushikana, nyaya dzisina maturo, kushungurudzika, kusazviremekedza uye hupenyu hwose.
- Shanduro yepamapapu inonzi Laparoscopic : Iyi nzira itsva ichangobva kuve yakakurumbira muUnited States. Munguva iyi nzira, vanachiremba vanovhiya vanobva pakati pe75 ne80 muzana yemudumbu pavanenge vachibva kune imwe gumbo. Pakutanga, nyanzvi dzakafunga kuti nzira iyi yaingova inodzivirira; zvisinei, kutsvakurudza kwemazuva ano kwakaratidza kuti iyi nzira inowedzerawo kusunungurwa kwezvinonzi incretins kana mahomoni zvinokurudzira kusunungurwa kwe insulini nepascreas. Kunyange zvazvo tsvakurudzo dzakawanda dzinofanirwa kuitwe kuongorora kufanirwa kwekugadzirisa sleeve gastrectomy, zvinoratidzika kuti sleeve gastrectomy inofananidzwa neRux-en-Y gastric inopass in terms of weight-loss and metabolic effect, ine zviyero zvakafanana zvechirwere cheshuga kuregererwa uye kuderedzwa kwehutano hwechirwere cheshuga uye zvipingamupinyi.
- Ipaparoscopic yakagadziriswa mabheji : Gastric lap band nzira inosanganisira kuisa boka rakapoteredza chikamu chepamusoro chemukati kuti rive nehombodo shomanana izvo zvinoita kuti satiety yapfuura. Nemhaka yokuti gastric lap band inonyanya kusvibisa kupfuura mamwe maitiro ekuvhiya kwemagetsi-sleeve gastrectomy uye Roux-en-Y - zvinotora nguva yakawanda kuti zviite kuti kuora muviri kuwedzere uye kuvandudzirwa kwechirwere cheshuga. Kunyange zvakadaro, pakati pe50 ne80 muzana yevanhu vanogashira iyi nzira yekuziva kuregererwa kwechirwere cheshuga. Uyezve, vanhu vanogamuchira nzira iyi vanoonawo kuderera kwezvikwata zveputi, kunyange zvazvo zvishoma zvishoma kudarika zvakaderera kuonekwa pashure pemamwe marudzi ekuvhiya kwemagetsi.
- Biliopancreatic diversion ne duodenal switch (BPD / DS) : Pasingapindi mune nitty-gritty, ndapota ramba uchiyeuka kuti, sezvo zvichida inogona kuderedzwa kubva kune zita racho, BPD / DS inzira yakaoma inosanganisira zvakawanda zvegadziriro yekugadzirisa. Izvozvi kuvhiyiwa zvose zvinodzivirira uye malabsorptive uye zvinotarisirwa kune vanhu vakawanda vakaoma (funga BMI inopfuura 50). Chinonyanya kukosha, BPD / DS inoguma mumatunhu makuru uye akachengetedza ekurasikirwa kwemazivi mukati mekuvhiya kwemagetsi uye kuwedzera kukuru kwechirwere cheshuga nemaprofidhi emadzimai. Ichokwadi, zvimwe zvidzidzo zvakaratidza kuti inenge 100 muzana yevanhu vanogamuchira iyi nzira inoshushikana nechirwere cheshuga kuregererwa! Uyezve, BPD / DS inoratidzika nokuda kwekuvandudza kupererwa kwepabonde pakati pevarwere vanoiwana. Kunyange zvakadaro pamusana pehupenyu hwahwo hwakanyanya-kuronga zvakare nekucheka chirwere chinotanganisa chinokonzera migumisiro yakaipisisa-vanhu vanogamuchira izvi zvinowanzova pangozi yekushaya kukwana kwezvokudya, zvimwe zvacho zvisinganzwisisiki uye zvinogona kutyisidzira upenyu.
Muna 2013, inofungidzirwa kuti 179 000 kuyerwa kwekureruka-kurasikirwa kwakaitwa. Heino kuparara:
- 42 muzana yakanga iri sleeve gastrectomy
- 34 kubva muzana vaiva gastric inpass
- 14 muzana vaiva gastric lap band
- 1 muzana vaiva BPD / DS
- 6 kubva muzana dzakanga dzakadzokororwa
Ngozi
Kakawanda, chirwere chemagetsi hachina kuchengeteka, kunyanya kana chakaitwa nechiremba wechiremba ane ruzivo kune murwere akagadzirira nzira yacho uye akazvipira kuti kubudirire kwegadziriro yacho. Zvisinei, sekuvhiya kwose, zvinhu zvakaipa zvinogona kuitika mushure mekuvhiyiwa kwemagetsi. Nokudaro, kuvhiyiwa kwemigodhi kuchiri kutaridzirwa kwechipiri-mishonga kurapwa uye yakachengeterwa vanhu vanokundikana kurapwa nenzira yekudya, kurovedza muviri, uye mishonga.
Heano zvimwe zvipingamupinyi zvakashata zvine chokuita nekuvhiyiwa kwemagetsi. Ndapota cherechedza kuti migumisiro iyi yakaipa inowirirana zvichienderana nenzira yakarongwa inoitwa. Somuenzaniso, Roux-en-Y uye BPD / DS inonyanya kuparadza uye inogona kuguma nemigumisiro iyi yakaipa; asi, gastric lap band inowanzoguma nemigumisiro yakawandisa yakaipisisa isingabatanidzi matumbo chaiwo.
- Mishonga uye noutano hwakakosha
- Ulcers
- Gastric remnant distension inotungamirira kueusus (kugadziriswa kwegomba)
- Cholelithiasis (gallstones)
- Hernia panzvimbo yekutsvaira
- Kubvuma (nzvimbo dzakasimba dzinogunzva uye dzinodzivisa maronda)
- Dumping syndrome
- Kuora kweiyo
- Kurwara
- Stenosis
- Kudengenyeka kwebhanhire (ine band band)
- Shanduka mumitemo yemapfupa
- Reflux
Urongwa uhwu hahuna kunyatsopera kana hunoti kune chero rudzi rumwe rwekuvhiya kwemagetsi. Ndapota tsvaka kunyatsotsvaga kutsvaga maitiro anorwadza ekuvhiyiwa usati waita chero yakadaro. Uyezve, kurukurai izvi zvinokonzera kukuvadza zvakadzama pamwe nechiremba wako uye nheyo yehutano. Kuvhiyiwa kwemetabolic haisi chirongwa chepachikafu chinoporesa zvirwere zvako zvose pasina chikonzero. Pane kudaro, ichisarudzo chakasarudzwa chinoita kuti uvandudze hutano hwako.
Ndezvipi Zvirwere Zvine Diabesity Ndevashandi Vekuvhiya Mishonga?
Sezvambotaurwa, kwekutanga kokutanga nyanzvi dzeDSS-II dzakakurudzira chirongwa chekurapa kwekurapa chirwere cheshuga nekuvhiya. Zvinonyanya kukosha, nyanzvi dzinokurudzira kuti kuvhiyiwa kunofungidzirwa kune vanhu vanongopfurikidza (BMI pakati pe30 ne 34.9) vane chirwere cheshuga chisingaitwi nemuromo wemishonga kana insulin.
Heano mazano ekurapa chaiwo kune vanhu vane chirwere cheshuga:
- Kuvhiyiwa kwemagetsi kunofanira kukurudzirwa kune varwere vane klasi III kuneta (BMI inopfuura 40) vanoramba vasina kutenderwa nenzira yekuchinja mararamiro (kudya uye kurovedza muviri) uyewo kurapwa (muromo wemishonga uye insulini).
- Saizvozvowo, kuvhiyiwa kwemagetsi kunofanira kukurudzirwa kune varwere vane klasi yechipiri kukura (BMI pakati pe35 ne35.9) vanoramba vakasachengetedzwa pasinei nekuchinja mararamiro uye kurapwa.
- Sezvambotaurwa pamusoro apa, chirwere chemagetsi chinofanira kufungidzirwa kune vanhu vakaoma (BMI pakati pe30 ne 34.9) uye havagone kuwana simba rekushaya chirwere cheshuga pasinei nekuchinja kwezvokudya uye zvekurovedza muviri uyewo kurapwa kwemishonga nemuromo wemishonga uye insulin.
Nyanzvi dzinokurudzirawo kuti idzi zvikumbaridzo uye zvigadziriswe zvigadziriswa pasi kune vanhu veAsia. Zvinofanira kuonekwa kuti kunyange zvazvo zviratidzo zvekurapa chirwere cheshuga nekuvhiya pamwe nekuwanda kwehutatu hwakarasika nevanhu vemadzinza akasiyana-siyana vanogona kusiyana, kunyatsovandudzika kwechirwere cheshuga uye kuregererwa kwemari mushure mekuvhiyiwa kunoenzaniswa pakati pemarudzi ose. Mune mamwe mazwi, kuvhiyiwa kwakafanana kunobatsira vanhu vemarudzi ose maererano nekuvandudzwa kwechirwere cheshuga nekuregererwa kwezvirwere.
Pane imwe nhoroondo yakabatana, nokuti chirwere chechirwere cheshuga hachina kuzongotaridzirwa se "munhu mukuru" uye chinokanganisa nhamba inowedzera uye inotyisa yevana nevechiri kuyaruka, nyanzvi dzinokurudzira kuti mamwe ongororo anotsvakurudzwa kuti ajekese basa rekuvhiyiwa kwemagetsi mukurapa kwevana vane chirwere cheshuga. Uyezve, nyanzvi dzinokurudzira zvakare kutsvakurudza nezvekuti chirwere chinogona kubatsira zvakanyanya vanhu vane chirwere cheshuga cheshuga. Kunyanya, kune vanhu vane chirwere cheshuga chechirwere chepabonde, chirwere chebhaatric chinogona kuita kuti zvirwere zveglycemic zvirambe zviri nani uye kuderedza insulin zvinodawo uye pamwe nehuwandu huri hwehutano hwemwoyo.
Kunyatsoronga Kuvhiya Kwemakemikari Kunobata Diabesity Here?
Nzira dzinoshandiswa nekuvhiyiwa kwemagetsi kana chirongwa chechirwere chinokonzera chirwere cheshuga chakaoma uye chinopindirana. Zvechokwadi, kuvandudzwa kana kukanganwirwa kwehuga hwechirwere hunokonzerwa nekuvhiyiwa kwakadaro kune zvakawanda zvine chokuita nekoriori kudzivirira uye kurasikirwa kwekureruka. Zvisinei, kune zvimwe zvimwe zvakawanda zvinokonzera kurapwa kwechirwere cheshuga kusanganisira zvinotevera:
- Kuchinja mu bile acid metabolism
- GI turakiti inonzwa uye kushandiswa kweglucose
- Incretin release (yeuka kuti incretins inokurudzira kusunungurwa kwe insulin nepascreas)
- Izvo zvinoita basa rekupikisa-incretins
- Kuchinja mumvura yegomba (kuumbwa kwebhakitiriya inogara mumatumbo)
Zvingangodaro, izvi zvinokonzerwa nezvimwe zvatisati tati tibvumirane kuwirirana zvinokonzera kugadzirisa chirwere cheshuga nekuregererwa mushure mokuvhiyiwa. Uyezve, dzimwe nzira idzi dzinoenderana nemhando yekuvhiya iri kuitwa.
Shoko Rinobva
Kana iwe kana munhu waunoda ane chirwere cheshuga chisingadzorwi nekudya, kurovedza muviri, uye mishonga, unogona kuda kukurukura kubatsira kwekuvhiya kwemagetsi pamwe nechiremba wako. Kunyange zvazvo kuvhiyiwa kwakadaro kusati kwambotanga kurapwa kwemasikati, kurapwa kwakadai kunogona kukubatsira kuti usabatwa nechirwere cheshuga uye kutambura.
Kungofanana nezviyero zvechigarire uye zvisingasviki zvinogona kusabata chirwere cheshuga, izvo hazvirevi kuti mamiriro ako haana tariro kana unhu hwehupenyu huchazombovandudza. Ndapota fungai mupfungwa kuti kushandiswa kwemagetsi kunowanzochengetedzwa nenzira ine hutano ine huwandu hwehutano hunobatsira kusanganisira kurapa rudzi rwechipiri chirwere cheshuga. Uyezve, cherechedza, zvisinei, kuti kuvhiyiwa kwemagetsi ndiko kushanda kunoda zvakawanda zvokugadzirira, kufunga, kukurudzira, nekuzvipira. Kuvhiya kwakadaro hakumboiti kugadziriswa nekukurumidza kana nyore uye kunoda nguva yeupenyu yekuzvigadzirisa utano hwehutano uye kugadziriswa kuita zvisarudzo.
Kana iwe uine mibvunzo ine chokuita nehutachiwana kana chirwere chekureruka-kurasikirwa, ita nguva yako nechiremba wako kuti ukurukure zvaunofunga nezvisarudzo.
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