Phakathi neminyaka embalwa eyedlule, sizuze ekuthuthukeni okungakaze kwenzeke ekuqondeni kwethu isifo sikashukela , ukuqapha , ukuphathwa kanye nokwelapha . Lezi zintuthuko zibandakanya ukuqonda kangcono izinkinga ezincane ezincane neziyinkimbinkimbi zalesi sifo- "ezincane ezincane" kubhekisela emithonjeni encane yegazi kanye "nemisindo eminingi" ibhekisela emithanjeni emikhulu yegazi, njengaleyo etholakala enhliziyweni nasebuchosheni-kanye nokuqhubekayo (" ukuhlakanipha ") ukuqapha i-glucose ngisho nekilasi elisha lesifo sikashukela: i-sodium-glucose cotransporter 2 (SGLT2) inhibitors njenge-Invokana.
Noma kunjalo, zonke lezi zintuthuko zisho kancane kubantu abaningi abanesifo sikashukela. Naphezu kokwelashwa okungcono kanye nokuphathwa, abangaphansi kwamaphesenti angama-50 alabo abanesifo sikashukela abanesifo sikashukela abanomthwalo okwanele wokushukela egazini futhi basengcupheni yesifo sikashukela, kanti amaphesenti angama-80 abantu abanesifo sikashukela abanenkinga yesifo senhliziyo.
Kusukela ngasekupheleni kwawo-1980, abacwaningi nabahlengikazi baye baphawula ukuthi abantu abaningi abanesisindo esibi kakhulu nesifo sikashukela, noma abantu abanesifo sikashukela, abathola isisindo somzimba, noma i-bariatric, isipiliyoni sokuhlinzwa baqhubekisela phambili ukuthuthukiswa kokulawulwa kwe-glycemic kanye nokwehla kwengozi ye-cardiovascular. Ngaphezu kwalokho, abanye abantu abathola ukuhlinzwa komzimba bahlangabezana nokuxolelwa okungekho emthethweni futhi akusadingeki ukuthi bathathe imithi! Noma kunjalo, naphezu kwalokhu okubonwayo, ochwepheshe baye besaba ukutusa izincomo zokuqondisa iziqondiso eziphathelene nendawo yokuhlinzeka ekwelapheni uhlobo lwesifo sikashukela sohlobo lwesifo sikashukela ... okungukuthi, kuze kube sekuqedile iSikhumbuzo Sokuhlinzwa Sikashukela (DSS-II) ngoSepthemba 2015 .
Inothi, nakuba livame ukusetshenziselwa ngokungafani, ukuhlinzwa kwe-bariatric kubhekisela ekuhlinzekeni kwesisindo, kanti ukuhlinzekwa ngokwemithi kubhekisela ekuhlinzekeni okwenziwa ukuze kuthuthukiswe isifo sikashukela nesifo se-metabolic.
Ku-DSS-II, izazi ezivela emhlabeni wonke ngokubambisana nezinhlangano zezokwelapha ezi-45 ezihola, kuhlanganise nezinhlangano eziyisithupha ezihola isifo sikashukela: i-American Diabetes Association, International Diabetes Federation, iShayina Diabetes Society, i-European Association for the Study of Diabetes Diabetes India, futhi Isifo sikashukela UK, sabukeze bonke ubufakazi obutholakalayo futhi senza izincomo zomhlaba wonke eziguquguqukayo mayelana nokuhlanganiswa kwezikwelapha zokwelapha nokwelapha ekwelapheni isifo sikashukela.
Futhi banikeze isiqondiso esidinga kakhulu mayelana nokukhethwa kwabafundi abahlinzekwayo kanye nokubili izincomo zokulandela nokulandela ngemuva kokulandela.
Izinhlobo Zokuhlinza Ngokwemetaboli
Ukuhlinzwa kwe-weight-loss has received many press over the years. Ngakho-ke mhlawumbe unomqondo wokuthi yiziphi ezinye zalezi zinqubo ezibandakanya. Noma kunjalo, ake senze ukuvuselela okusheshayo okumboza izinhlobo ezine eziyinhloko zokuhlinza umzimba.
- I-Roux-en-Y isisu se-gastric . Le nqubo yinkqubo ye-bariatric evame kakhulu eyenziwa emhlabeni jikelele. Lokhu kuhlinzwa kwenziwa nge-laparoscopically, noma nge-minimalally invasive izindlela, futhi kubangelwa ukulahlekelwa kwesisindo esikhulu kanye nokuthuthukiswa kwesifo sikashukela. I-roux-en-Y ye-gastric bypass ihilela ukudala isikhwama esiswini esiswini sangasese bese sihlanganisa lesi sikhwama esincane ngqo emathunjini ngaleyo ndlela sidlulisa ukugwinya okukhulu kwesisu nesisu.Umphumela ohlangene walokhu kungenelela akugcini nje ukwehlisa isisu indawo ebusweni futhi kubangele ukuphefumula kwangaphambili, noma umuzwa wokugcwala, kodwa futhi kunciphisa kakhulu ukumunca kwamafutha. Inothi, izinqubo ze-bariatric ezishintsha usayizi wesisu zibizwa ngokuthi zivimbela; kanti, lokho okugcoba ngamathumbu kanye nokuguqula imfucuza kubizwa ngokuthi i-malabsorptive. Abantu abangaphezu kwamaphesenti angama-75 abantu abanesifo sikashukela abawela ohlelweni lwe- Roux-en-Y lwesisu esiswini bazokwazi ukuxolelwa. Ngaphezu kwalokho, amaphesenti angaphezu kuka-90 alawa gciwane azothola ukuthuthukiswa kwamanye ama-biomarker of disease metabolic, okufaka phakathi ukwehla kwamanqanaba e-lipid (cholesterol ne-triglyceride). Ukuqalisa, abantu abathola lokhu kuhlinzekwa nabo bathi ukuyeka i-GERD (ukushaya kwenhliziyo) kanye nokuqiniswa kobuhlungu obuhlangene, ukucindezeleka, izinkinga zokungabi nabantwana, ukucindezeleka kokungaziphathi kahle, ukuzethemba kanye nekhwalithi yonke yokuphila.
- I-laparoscopic sleeve gastrectomy : Le nqubo entsha kakhulu iyashesha kakhulu e-United States. Phakathi nale nqubo, odokotela abahlinzayo basusa phakathi kwamaphesenti angu-75 no-80 wesisu ngenkathi beshiya konke okusemathunjini. Ekuqaleni, ochwepheshe bacabanga ukuthi le nqubo yayikuvimbela kuphela; Nokho, ucwaningo lwamuva lubonisa ukuthi le nqubo ibuye ikhulise ukukhululwa kwama-incretin noma ama-hormone okukhuthaza ukukhululwa kwe-insulin ngama-pancreas. Nakuba kucwaningo olwengeziwe oludingeka lwenziwa kwenziwe uphenyo ngezinzuzo ze-sleeve gastrectomy, kubonakala sengathi i-gastrectomy ye-sleeve ifaniswa ne-Roux-en-Y isisu esiswini ngokuya kwesisindo-ukulahlekelwa kanye nemiphumela emizimba, enezinga elifanayo lokususwa kwesifo sikashukela nokunciphisa ukucindezeleka kwesifo sikashukela kanye nezici ezingozini.
- I-laparoscopic banding adjustable : Inqubo ye-lap gastric band band ihlanganisa ukubeka ibhande nxazonke ezingxenyeni ezingenhla zesisu ukudala isikhwama esincane esenza ukuthi satiety ngaphambili. Ngoba i-band band ye-gastric ayinamandla kakhulu kunezinye izinhlobo ze-gastrectomy kanye ne-Roux-en-Y yokuhlinzwa okuyisimiso sokudla komzimba-kuthatha isikhathi eside ukuze kubangele ukulahlekelwa isisindo nokuthuthukisa isifo sikashukela. Noma kunjalo, phakathi kwamaphesenti angu-50 no-80 abantu abathola le nqubo isipiliyoni sokuxolelwa kwesifo sikashukela. Ngaphezu kwalokho, abantu abathola le nqubo nabo banciphisa amazinga e-lipid, nakuba aphansi kancane kunokuncipha okubonwe ngemva kwezinye izinhlobo zokuhlinzwa kwamathambo.
- Ukuguqulwa kweBiliopancreatic ne-duodenal switch (BPD / DS) : Ngaphandle kokungena ku-nitty-gritty, sicela uhlale ukhumbule ukuthi, njengoba kungenzeka ukuthi yenziwa ngegama layo, i-BPD / DS iyinkambinkimbi eyinkimbinkimbi ehilela ukulungisa kabusha kwamathambo. Lokhu kuhlinzekwa kokubili kungavinjelwe futhi kusetshenziselwa ukubhebhethekisa futhi kuhloswe ngabantu abakhulu kakhulu (cabanga nge-BMI enkulu kunama-50). Okubaluleke nakakhulu, i-BPD / DS ibona amazinga amakhulu kakhulu futhi azinzile kakhulu ekulahlekeni kwesisindo phakathi kwazo zonke izinqubo zokuhlinza umzimba kanye nokuthuthukiswa okukhulu kwesifo sikashukela namaphrofayela e-lipid. Eqinisweni, ezinye izifundo ziye zabonisa ukuthi cishe amaphesenti angu-100 abantu abathola le nqubo abhekana nokukhululwa kwesifo sikashukela! Ngaphezu kwalokho, i-BPD / DS ibonakala ngokuthuthukisa kakhulu i-apnea yokulala phakathi kweziguli ezitholayo. Noma kunjalo ngenxa yemvelo yayo emangalisayo-ukulungisa kabusha futhi ukusika imvula ngokuyisimangaliso kubangele imiphumela emibi-abantu abathola le nqubo bengozini enkulu yokwehluleka kokudla okunomsoco, okunye okungaqondakali kahle futhi kungasongela ukuphila.
Ngo-2013, ukuhlinzekwa okulinganiselwa ku-179,000 ukulahlekelwa isisindo kwenziwa. Nansi ukuphazamiseka:
- Amaphesenti angu-42 kwakungu-gastrectomy yemikhono
- Amaphesenti angu-34 ayedlulile
- Amaphesenti angu-14 kwakungu-band gastric band band
- Amaphesenti angu-1 kwakungu-BPD / DS
- Amaphesenti angu-6 ahlaziywa
Izingozi
Ngokuvamile, ukuhlinzeka ngokwemithi kunesiphephelo, ikakhulukazi uma kwenziwa udokotela ohlinzayo ongugulane olungiselele inqubo futhi ozibophezele ekuphumeleleni kwenqubo. Kodwa-ke, njengazo zonke izindlela zokuhlinza, izinto ezimbi zingenzeka ngemuva kokuhlinzwa okuyisimangaliso. Ngakho-ke, ukuhlinzeka ngokwemithi kusadingeka kuthathwe ukwelashwa kwemigqa yesibili futhi kugcinwe abantu abahluleka ukwelashwa ngokudla, ukuzivocavoca, kanye nemithi.
Nakhu eminye imiphumela emibi ehlobene nokuhlinzekwa komzimba. Sicela uqaphele ukuthi le miphumela emibi ihlukahluka kuye ngokuthi inqubo ecacisiwe eyenziwe. Isibonelo, iRoux-en-Y ne-BPD / DS zihlasela kakhulu futhi zingabangela imiphumela eminingi embi; kanti, i-lap gastric band band ngokuvamile iholela emiphumeleni emincane kakhulu engavumelani namathumbu angempela.
- Ukuntuleka kwe-metabolic and nutritional
- Izilonda
- Insalela ye-gastric distension eholela e-ileus (isisu sokuvimbela)
- I-Cholelithiasis (ama-gallstones)
- U-Hernia esakhiweni socingo
- Ukuxhaswa (izindawo ezinamathelayo eziphazamisa futhi ezivimbela isilonda)
- I-dumping syndrome
- Ukuhluleka kwezinso
- Ukutheleleka
- Stenosis
- Ukuguguquka kwamabhande (nge-band band)
- Shintsha emikhumeni yemilenze
- Reflux
Lolu hlu alukwazi ukuphelela noma oluqondile kunoma yiluphi uhlobo olulodwa lokuhlinzwa okuyisimangaliso. Sicela ucwaninge ngokucophelela imiphumela engaba yingozi yokuhlinzwa ngaphambi kokuba wenze noma iyiphi inqubo enjalo. Ukwengeza, xoza ngemiphumela emibi ngokuningiliziwe nodokotela wakho ohlinzayo kanye nethimba lezempilo. Ukuhlinzwa kwamathambo akuyona i-panacea eyokwelapha zonke izifo zakho ngaphandle kokulandela. Kunalokho, isinqumo esilinganiselwe esenziwe ukuthuthukisa impilo yakho.
Iziphi Iziguli Ezinesifo Sikashukela Abayizicelo Zokwelashwa Kwemithi?
Njengoba kushiwo ngaphambili, okokuqala ochwepheshe be-DSS-II banconywa i-algorithm yokwelashwa yokwelashwa kwesifo sikashukela ngokusebenzisa ukuhlinzwa. Okubaluleke kakhulu, ochwepheshe batusa ukuthi ukuhlinzwa kubhekwa kubantu abahamba ngokweqile (BMI phakathi kuka-30 no-34.9) abanesifo sikashukela esingalawulwa ngemithi yomlomo noma i-insulin.
Nazi izincomo zokwelashwa eziqondile kubantu abanesifo sikashukela:
- Ukuhlinzeka ngamathambo kumele kunconywe ezigulini ezinezinga eliphezulu kakhulu (i-BMI engaphezu kuka-40) abahlala bengalawulwa ngendlela yokushintsha impilo (ukudla nokuzivocavoca) kanye nokuphathwa kwezokwelapha (imithi yomlomo kanye ne-insulin).
- Ngokufanayo, ukuhlinzekwa kwemithi kufanele kuphakanyiswe ezigulini ezinezinga eliphezulu kakhulu (i-BMI phakathi kuka-35 no-35.9) abahlala bengalawuliwe naphezu kokuguqulwa kokuphila nokuphathwa kwezokwelapha.
- Njengoba kuphawuliwe ngenhla, ukuhlinzekwa kwezidakamizwa kufanele kubhekwe kubantu abakhuluphele (i-BMI phakathi kuka-30 no-34.9) futhi abakwazi ukuzuza ukulawulwa kwesifo sikashukela naphezu kokushintsha kokudla nokuzivocavoca kanye nokuphathwa kwezokwelapha ngemithi yomlomo kanye ne-insulin.
Ochwepheshe nabo batusa ukuthi lezi zingqimba kanye nezinqamuleli zihlelwe phansi kubantu base-Asia. Kumele kuqashelwe ukuthi nakuba izibonakaliso zokwelashwa kwesifo sikashukela ngokusebenzisa ukuhlinzwa kanye nesisindo esilahlekelwa abantu bezinhlanga ezahlukene zingase zihluke, ukuthuthukiswa kwangempela kwesifo sikashukela kanye namanani okukhululwa ngemva kokuhlinzwa kufaniswa phakathi kwazo zonke izinhlanga. Ngamanye amazwi, ukuhlinzeka ngokufanayo kubasiza abantu bazo zonke izinhlanga ngokuqondene nokuthuthukiswa kwesifo sikashukela nokukhululwa kwezifo.
Kule ncazelo ehlobene, ngoba uhlobo lwesifo sikashukela sika-2 alubheki nje kuphela "ukuqala komuntu omdala" futhi kuthinta inani elikhulayo nelesabekayo labantwana nezingane ezisenganeni, ochwepheshe batusa ukuthi ucwaningo oluqhubekayo luqhutshwe ukuze luqede indima yokuhlinzwa kwamangqamuzana ekwelapheni izingane isifo sikashukela. Ngaphezu kwalokho, ochwepheshe nabo batusa ucwaningo oluqhubekayo ngokuthi ngabe ukuhlinzwa kungasiza kakhulu abantu abagulayo abanesifo sikashukela sohlobo 1. Ngokuqondile, kubantu abanesifo sikashukela sohlobo 1, ukuhlinzeka nge-bariatric kungenza kube lula ukulawulwa kwe-glycemic futhi kunciphise izidingo ze-insulin kanye nencishwana enciphise yesifo senhliziyo.
Ukuhlinzwa Ngokuyisimangaliso Kanjani Ngokuqondile Ukwelapha Isifo Sikashukela?
Izindlela okuhlinzekwa ngayo umzimba noma isifo sokudla ngesifo sikashukela kuyinkimbinkimbi futhi kuhlangene. Ngokuqinisekile, ukuthuthukiswa noma ukukhululwa kwesifo sikashukela okubangelwa ukuhlinzwa okunjalo kunokuningi okukwenza ngekhalori ukuvimbela nokulahleka kwesisindo. Kodwa-ke, cishe kunezinye izici eziningi ezenza ukwelashwa kwesifo sikashukela kufaka okulandelayo:
- Izinguquko nge- bile acid metabolism
- I-GI ipheshana ukuzwa nokusetshenziswa kwe-glucose
- Ukukhululwa kwe-Incretin (khumbula ukuthi ama-incretins akhuthaza ukukhululwa kwe-insulini ngama-pancreas)
- Indima engenzeka ye-anti-incretins
- Izinguquko ezinhlotsheni zamanzi (ukwakhiwa kwama-bacteria ahlala emanzini)
Mhlawumbe, le miphumela kanye nabanye esisazokwazi ukuhlukanisa ukusebenzisana ukuze kubangele ukuthuthukiswa kwesifo sikashukela nokuxolelwa emva kokuhlinzwa. Ngaphezu kwalokho, ezinye zezinqubo ezixhomeke kulolu hlobo lohlinzekwa olwenziwa.
Izwi elivela
Uma wena noma othandekayo enesifo sikashukela esingalawulwa ngokudla, ukuzivocavoca, kanye nemithi, ungase ufune ukuxoxa ngezinzuzo zokuhlinzekwa komzimba nodokotela wakho. Nakuba ukuhlinzeka okunjalo akukaze kubekwe ukwelashwa kwemigqa yokuqala, ukuhlinzwa okunjalo kungakusiza ugweme ukucindezeleka nesifo sikashukela.
Kungenxa yokuthi izinyathelo ezivamile nezingenakuvama zingase zingaphatheki isifo sikashukela sakho, lokho akusho ukuthi isimo sakho asikho ithemba noma izinga lakho lokuphila ngeke lithuthuke. Sicela uhlale ukhumbule ukuthi ukuhlinzeka ngokwemithi kuyindlela ejwayelekile ephephile enezinzuzo eziningi zempilo kubandakanya ukwelashwa kwesifo sikashukela sohlobo lwe-2. Kodwa futhi, phawula ukuthi ukuhlinzekwa kwemithi kuyinkqubo edinga ukulungiselela, ukucabanga, ukugqugquzela nokuzibophezela okuningi. Ukuhlinza okunjalo akukona ukulungisa okusheshayo noma okulula futhi kudinga isikhathi esiphila ngaso sokugcinwa kwezempilo okuzinikezele nokwenza izinqumo ezinolwazi.
Uma unemibuzo mayelana nokuhlinzwa kwesifo sikashukela noma isisindo sokulahlekelwa isisindo, yenza i-aphoyintimenti nodokotela wakho ukuxoxa ngezinto ozikhathazayo nezinketho zakho.
Imithombo:
I-Batterham RL no-Cummings DE. Izindlela Zokuthuthukiswa Kwesifo Sikashukela Ukulandela Ukwelashwa kweBariatric / Ukuhlinzwa Kwemithi. Ukunakekelwa yisifo sikashukela 2016 Jun; 39 (6): 861-877.
UCefalu WT, uRubino F noCummings DE. Ukwelashwa Kwemetabolic for Type 2 Isifo Sikashukela: Ukuguqula Indawo Yesifo Sikashukela. Ukunakekelwa yisifo sikashukela 2016 Jun; 39 (6): 857-860.
U-Ellsmere JC, uJones D noKen W. Izinkinga ezihamba phambili zokuhlinzwa kwe-bariatric. UpToDate 2016.
URubino F, uNathan DM, u-Eckel RH, et al. Ukwelashwa Kwama-Metabolic ku-Algorithm Yokwelapha Yesibili Soshukela Sesibili: Isitatimende Esihlanganisiwe Samazwe Kazwelonke Sikashukela. Ukunakekelwa yisifo sikashukela 2016 Jun; 39 (6): 861-877.
Schauer PR, Schirmer B. Ukuphathwa Okuhlinzekwa Ukukhuluphala. Ku: Brunicardi F, Andersen DK, B Billiar, Dunn DL, Hunter JG, Matthews JB, Pollock RE. ama-eds. Izimiso Zokuhlinza Schwartz, 10e . ENew York, NY: McGraw-Hill; 2014.