THE CONTROL OF DIABETES-MELLITUS (NIDDM) IN THE MORBIDLY OBESE WITH THE GREENVILLE GASTRIC BYPASS
THE CONTROL OF DIABETES-MELLITUS (NIDDM) IN THE MORBIDLY OBESE WITH THE GREENVILLE GASTRIC BYPASS
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DOI：
10.1097/00000658-198709000-00009
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发表时间：
1987-09-01
影响因子：
9
通讯作者：
SWANSON, MS
中科院分区：
文献类型：
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作者：
PORIES, WJ;CARO, JF;SWANSON, MS
自1980年2月1日以来，已对397例病态肥胖患者进行了相同的标准化格林维尔胃旁路手术，手术死亡率为0.8%。手术有效地控制了体重，并在6年后保持了令人满意的体重减轻(平均体重和范围：术前：290磅（196-535）；18个月：175磅（110-300）；72个月：205磅（140-320）。胃旁路手术对非胰岛素依赖型糖尿病（NIDDM）、高血压、身体和角色功能以及一些心理健康指标有积极影响。严格的随访（6年97.5%）显示术后患者普遍存在健康问题；有9人晚死。397例患者术前有141例（36%）存在糖代谢异常，88例（22%）存在NIDDM， 53例（14%）存在糖代谢异常。在没有任何糖尿病药物或特殊饮食的情况下，除两人外，所有人在手术后4个月内血糖都达到了正常水平。本文对最近42例病态肥胖合并NIDDM患者进行了深入研究。在该队列中，手术后空腹血糖、空腹胰岛素和糖化血红蛋白恢复正常；胰岛素释放、胰岛素抵抗和葡萄糖利用显著改善。胃旁路手术后葡萄糖代谢的正常化可能不仅仅与体重减轻和热量摄入的限制有关，还可能与胃窦和十二指肠旁路手术有关。图片
Since February 1, 1980, the identical standardized Greenville Gastric Bypass has been performed in 397 morbidly obese patients with an operative mortality rate of 0.8%. The operation effectively controlled weight and maintained satisfactory weight loss even after 6 years (mean weights and ranges: Preoperative: 290 lbs (196-535); 18 months: 175 lbs (110-300); 72 months: 205 lbs (140-320). The gastric bypass favorably affected non-insulin-dependent diabetes (NIDDM), hypertension, physical and role functioning, and several measures of mental health. Rigorous follow-up (97.5% over 6 years) revealed that health problems were common in postoperative patients; there were nine late deaths. Abnormal glucose metabolism was present in 141 (36%) of 397 patients before surgery: NIDDM was present in 88 patients (22%) and 53 patients (14%) were glucose impaired. Of these, all but two became euglycemic within 4 months after surgery without any diabetic medication or special diets. The most recent 42 morbidly obese patients with NIDDM were studied intensively. In that cohort, fasting blood glucose, fasting insulin, and glycosylated hemoglobin returned to normal after surgery; insulin release, insulin resistance, and utilization of glucose improved sharply. The normalization of glucose metabolism after gastric bypass may not be related solely to weight loss and restriction of caloric intake, but may also be due to the bypass of the antrum and duodenum. Images