Dipatimenti ya Endocrine ndi Metabolic Opaleshoni MSCC

Cholinga choyambirira cha opaleshoni ya bariatric chinali kuchepetsa kunenepa kwambiri. Popita nthawi, zinafika podziwika za mankhwala othandizira Type II shuga mellitus atachitidwa opaleshoni ya bariatric, yomwe imawonedwa mwa odwala ambiri motsutsana ndi maziko a kuchepa thupi pambuyo pakuchita opareshoni. Pamaso pa kunenepa kwambiri komanso matenda opatsirana oyamba kwambiri (makamaka mtundu wachiwiri wa matenda a shuga), njira zosavuta kwambiri za bariatric (bandeji yam'mimba, masaya oyambira m'mimba) sizothandiza, ndipo zochitika zovuta kwambiri, monga gastric bypass kapena biliopancreatic bypass, zitha kudziwitsidwa kwa odwala. Tsopano zikuwonekeratu kuti zomwe zimayambitsa kuchira kwa matenda ashuga ndi matenda ena zimangodalira kuwonda, komanso kusintha kwina komwe kumachitika chifukwa cha opareshoni.

Njira yeniyeni yochizira matenda a shuga a II sichinadziwikebe. Amayesedwa kuti amatenga gawo limodzi popewa kuyamwa ndi kulowetsedwa kwa chakudya cham'mimba ndi mafuta m'matumbo, ndikusintha kayendedwe ka mahomoni ena am'matumbo (amatumbo), omwe amatsogolera pakuwonjezeka kwa insulin komanso kuwonjezeka kwa chidwi cha minofu yake.

Masiku ano pali umboni wamphamvu wasayansi woti opaleshoni ya bariatric imatha kuwonetsedwa kwa odwala omwe ali ndi matenda a shuga a 2 ngakhale asanakhale onenepa kwambiri. Pakadali pano, gawo lachiwiri la mayesero azachipatala pochiza matenda a shuga II odwala popanda kunenepa kwambiri pochita mtundu wina wa opaleshoni ya bariatric (leal transposition) ikuchitika padziko lapansi. Zambiri zam'mbuyomu zimanenanso kuti odwala matenda ashuga alipo 87% mwa odwala, komabe, maphunziro azachipatala akupitilizabe, ndipo zotsatira zazitali za njirayi sizidziwika mosakayikira.

Kuchita bwino kwambiri kwa opaleshoni ya bariatric chifukwa cha kunenepa kwambiri, matenda ashuga, matenda oopsa komanso matenda ena okhudzana ndi izi m'zaka zaposachedwa amatilola kulankhula opaleshoni ya metabolic – opaleshoni mankhwala a metabolic syndrome.

Metabolic syndrome yodziwika ndi kuwonjezeka kwa mafuta a visceral, kuchepa kwa chidwi cha minofu ku insulin ndi hyperinsulinemia, yomwe imasokoneza chakudya, lipid, purine metabolism, komanso matenda oopsa. Kufalikira kwa matenda a metabolic, malinga ndi malipoti ena, kumafika 25% mwa anthu ena. Malinga ndi malingaliro amakono, mawonetseredwe onse a metabolic syndrome amachokera ku insulin kukana (kukana kwa minofu yawo ku insulin) ndi hyperinsulinemia yofanana. Kugwiritsidwa ntchito kwa machitidwe achilendo, kuchititsa pathogenesis yamatenda, mtsogolo imatha kukhala njira yothandiza kwambiri pochizira kunenepa kwambiri, koma mawonetsedwe ena onse a metabolic syndrome.

Kuphatikiza pa matenda ashuga, opaleshoni ya bariatric imathandizanso prediabetes - Mkhalidwe womwe umatsogolera kukula kwa matenda ashuga ndipo ndi chimodzi mwamawonetsero oyamba a metabolic syndrome.

Mitundu ina ya kagayidwe kachakudya matenda, kukhala ndi kunenepa kwambiri, komanso kutsatiridwa pafupipafupi kugona tulo (kupuma ukugwira), kupumula ndi hypoxia, amatchedwa Matenda a Pickwick. Matendawa amachepetsa kwambiri moyo wa odwala ndikuwopseza kukula kwamwadzidzidzi.

Kudziwika kwa matenda a metabolic pagulidwe lapadziko lonse la matenda (ICD-X) kulibe. Zida zake zokha zomwe zimasiyanitsidwa: kunenepa kwambiri, mtundu II shuga mellitus, matenda oopsa oopsa ndi zovuta zina.

Chithandizo cha Conservative

Anthu omwe ali ndi matenda ashuga pano amatha kugwiritsa ntchito mitundu yambiri ya zakudya. Akhozanso kutenga maphunziro apadera. Kuchita bwino kwa njirayi ndikokwera kwambiri. Komabe, zotsatira zimatheka pokhapokha pakutsatira mosamalitsa malangizo onse a endocrinologist. Matenda a 2 a shuga amatha kuyimitsidwa mothandizidwa ndi kusintha kwakukulu pamakhalidwe, kuphatikiza machitidwe komanso thanzi. The endocrinologist ayenera kuuza wodwala zomwe angagwiritse ntchito komanso zomwe ayenera kuzipewa. Pakati pazoyambira zazikulu, kuchepa thupi nthawi zambiri kumayikidwa. Komabe, ndizovuta kwambiri kuti odwala asiye moyo wawo wamasiku onse. Pakadali pano, kuphwanya kulikonse kwa zakudya mosavomerezeka kumabweretsa zovuta zambiri, chifukwa cha kuchuluka kwa shuga m'magazi. Kuphatikiza apo, ndikofunikira kulingalira kuti odwala akukumana ndi vuto loti ayambe kusewera masewera ndikusintha machitidwe awo pazaka 40-60. Chifukwa chake, mwachilengedwe kuti anthu amakono ambiri samatha kutsatira zomwe akatswiri a endocrinologists amapanga.

Kukhalapo kwa matenda a shuga amitundu iwiri nthawi zambiri amakakamizidwa kumwa mankhwala apadera omwe amachepetsa shuga. Komabe, nthawi zambiri, chithandizo chotere sichothandiza. Kufufuza kuchuluka kwa shuga kumapangitsa kuti zikhale zosavuta kutsimikiza ngati kuchuluka kwake m'magazi ndikwabwinobwino. Ngati chizolowezicho chidapitilira, ndiye kuti mankhwalawo samabweretsa zotsatira. Chifukwa chake, ngati msanga wapezeka ndi shuga, ndikulimbikitsidwa kuti mulumikizane ndi endocrinologist posachedwa, yemwe angakonze zatsopano zothandizira odwala.

Opaleshoni

Cholinga chachikulu cha opareshoni ndikuchepetsa thupi. Zotsatira za njirazi zimawonekera bwino, chifukwa chitukuko cha matenda a shuga chimachitika nthawi zambiri mchikakamizo cha kuwonda. Nthawi zambiri, matenda amtundu wa 2 amakhudza anthu omwe ali ndi matenda osiyanasiyana onenepa.

Pali zochitika zosiyanasiyana momwe zimalimbikitsidwira kufunsa othandizira opaleshoni. Mwachitsanzo, ngati mwapezeka kuti muli ndi mtundu wachiwiri wa matenda ashuga, ndipo thupi lanu limaposa 40-50 kg. Kuchita opaleshoni kumachepetsa thupi, komanso kuthandizanso kupewa kufunika kwa kuchepetsa mankhwala ochepetsa shuga ndi zakudya zovuta. Kuphatikiza apo, pamene kulemera kumachepera, mavuto ena ambiri omwe amakhalapo chifukwa cha matenda ashuga komanso kunenepa kwambiri azithetsa. Pakati pawo, wina atha kutchula kupuma, kulephera kwa matenda a msana, matenda oopsa. Kuphatikiza apo, kupita kwa dokotala wa opaleshoni kumalimbikitsidwa milandu yomwe kugwiritsa ntchito njira zamankhwala kapena zolimbitsa thupi zalephera. Izi zikutanthauza kuti wodwalayo sangathe kusiya moyo wake wakale, kutsatira kadyedwe ndikuchita masewera olimbitsa thupi. Thandizo la opaleshoni lidzafunika kwa anthu omwe, kuphatikiza pa matenda ashuga, nawonso omwe ali ndi cholesterol yambiri. Kuphatikiza kotereku kumatha kuyambitsa matenda osiyanasiyana amtima. Opaleshoni yochita opaleshoni idzaonjezera kagayidwe kazakudya, kuchepetsa kuchuluka kwa mafuta m'thupi.

Zotsatira zoyambirira za opareshoni ziwoneka patatha sabata. Cholinga cha izi ndi zakudya zamafuta ochepa, zomwe wodwala amayenera kupita kumapeto kwa opaleshoni. Kuphatikiza apo, mafuta ogwiritsa ntchito panthawiyi amachepetsedwa kwambiri, ndipo chifukwa chake shuga amachepetsa. Kuchita opaleshoni ya m'mimba (1), opaleshoni ya m'mimba (2) ndi opaleshoni ya biliopancreatic bypass (3) salola ma sign kulowa mu kapamba. Chifukwa chake, chitsulocho chimasiya kugwira ntchito mopitilira muyeso. M'tsogolomu, kulemera kumachepa, zomwe zimapangitsa kuchepa kwa insulin. Matendawa ndi omwe amayambitsa matenda ashuga. Chifukwa cha kukhazikitsidwa kwa maopareshoni, nthawi yomweyo imakhudza njira zosiyanasiyana zomwe zimathandizira kukhazikitsa matenda a shuga a mtundu wachiwiri.

Asayansi aku America adachita kafukufuku yemwe adawonetsa kuti opaleshoni yam'mimba imathandizira odwala ambiri omwe ali ndi matenda ashuga. Ndizofunikira kudziwa kuti ndikhululuka kosasunthika palibe chifukwa chowonjezera chothandizira chokhudzana ndi kuchepa kwa shuga. Odwala safunika kumwa mankhwala osiyanasiyana a hypoglycemic. Nthawi yomweyo, alibe malamulo oletsa kugwiritsa ntchito zakudya zosiyanasiyana. Panthawi yochira pambuyo pochita opaleshoni, kuti zitheke, chakudya chochepa chimakhala chokwanira kwa wodwalayo. Izi zimachitika chifukwa chakuchepa kwa kuchuluka kwa m'mimba, komanso chifukwa choti chakudya chimalowa mwachangu mu ileamu. Chifukwa chake, kukwezedwa kumachitika kale. Komanso, kuyamwa kwa chakudya m'matumbo ang'onoang'ono kumachitika m'dera lalifupi.

Pakadali pano, ntchito zimachitika chifukwa cha laparoscopic access. Ndiye kuti, ma punctuff ang'onoang'ono angapo amapangidwa. Popeza palibe zikuluzikulu, mabala omwe akudwala amawachiritsa mwachangu kwambiri. Kuyesedwa kwawo kumachitika pang'onopang'ono, ndipo amafika kuchipatala kokha opareshoni isanachitike. Mchitidwewu, odwala ali ndi opaleshoni yodziwika bwino. Ola limodzi pambuyo pake, odwala ali ndi ufulu kuyenda. Ku chipatala ndikokwanira kuti akhale osaposa masiku asanu ndi awiri. Ngakhale opaleshoni imakhala yoopsa, zotsatira za zovuta za matenda ashuga zimakhala zazikulu kwambiri. Ntchito izi ndizovuta kwambiri, koma ngati sizichitika, zotsatirapo zake zitha kukhala khungu, kugwidwa, komanso kugunda kwa mtima ndi zovuta zina. Kuchita opaleshoni kumapangidwa ngati wodwalayo asintha mosasintha m'chiwalo chimodzi kapena zingapo zofunika, monga mtima kapena impso. Odwala omwe akutupa m'mimba kapena m'matumbo ayenera kukonzekera kwa nthawi yochepa opaleshoni.

Njira yothandiza kwambiri pa matenda a kunenepa kwambiri ndi gastroshunting. Zithandizanso mu shuga mellitus wa digiri yachiwiri. Chifukwa chake, madokotala ambiri opanga opaleshoni afotokozeranso mobwerezabwereza nkhani ya opaleshoni yodwala odwala matenda ashuga omwe si onenepa kwambiri. Komabe, ku Russia, opaleshoni yamankhwala othana ndi matenda a shuga sichichitika konse. Chifukwa chake, njirayi siyili mu pulogalamu yamatsimikiziro aboma. Odwala amakakamizidwa kudzipereka payekha kulipira ndalama zogwirira ntchito. Pakalipano, mtsogolomo, njira zopangira opaleshoni zimatha kukhala chozungulira chatsopano pakupanga njira zolimbana ndi matenda a shuga a 2.

Mu 2011, International Diabetes Federation idapanga lipoti loti athandize opareshoni ngati chithandizo cha matenda ashuga. Akatswiri angapo adasainira izi. Adawonetsa kuti ntchito zotere ziyenera kuchitidwa nthawi zambiri kuposa zomwe zikuchitika pano. Izi zithetsa mwayi wokhala ndi matenda osiyanasiyana a shuga. Bungweli lidaperekanso mndandanda wazomwe zingathandize pochiza matenda a shuga kudzera mwa opaleshoni:

1.1. Matenda a 2 a shuga komanso kunenepa kwambiri ndi matenda osatha omwe amayambitsidwa ndi zovuta za metabolic zomwe zimayambitsa chiopsezo chokufa.
1.2. Matenda monga matenda ashuga komanso kunenepa kwambiri afala kwambiri m'maiko ambiri padziko lapansi motero akhoza kuonedwa kuti ndi vuto lapadziko lonse lapansi. Chifukwa chake, ayenera kupatsidwa chidwi chapadera ndi machitidwe azaumoyo ndi maboma.
1.3. Kupewa kufalikira kwa matenda ngati amenewa kumatheka pokhapokha mukamagwiritsa ntchito mavutowa. Kuphatikiza apo, odwala onse omwe ali ndi matenda a shuga a mtundu wachiwiri ayenera kulandira chithandizo chabwino.
1.4. Kuchulukitsa kuchuluka kwa anthu odwala matenda ashuga kuyenera kukhala kwodziwika kwa othandizira azaumoyo. Odwala ayenera kulandira njira zothandiza kwambiri zothanirana ndi matendawa kuchokera patsikuli.
1.5. Chithandizo chikuyenera kuchitika osagwiritsa ntchito njira zamtunduwu komanso zamakhalidwe. Opaleshoni yam'mimba ndi njira inanso yabwino yothandizira anthu odwala matenda ashuga komanso kunenepa kwambiri. Kugwiritsa ntchito opaleshoni kumathandizira kukula kwa glucose. Kuphatikiza apo, kufunikira kwa mankhwala kumatsika kapena kumatha. Chifukwa chake, kuthekera kwa magwiridwe antchito ngati njira yothanirana ndi matenda a shuga ndikwambiri kwambiri.
1.6. Mothandizidwa ndi opaleshoni ya bariatric ndikotheka kuchitira anthu omwe sakanakhoza kuchiritsidwa pambuyo pa kugwiritsa ntchito mankhwalawa. Nthawi zambiri amakhalanso ndi matenda osiyanasiyana ophatikizika.
1.7. Kwa odwala omwe ali ndi matenda a shuga a mtundu wachiwiri ndi BMI ya 35 ndipo pamwambapa, opaleshoni ingakhale yovomerezeka.
1.8. Ngati BMI mwa odwala ndi 30-35, ndipo chithandizo chomwe sichisankha sichingathandize kuchepetsa matenda a shuga, ndiye kuti opaleshoni ingawaganizire ngati njira ina yabwino.
1.9. Poyerekeza ndi nzika zaku Asia ndi oimira amitundu ina omwe ali pachiwopsezo chachikulu, lingaliro lingasinthidwe ndi 2,5 kg / m2 pansi.
1.10. Kunenepa kwambiri ndi matenda osatha a zovuta zambiri. Kuphatikiza pa zochenjeza pagulu zomwe zimalongosola mawonekedwe a kunenepa kwambiri, odwala ayenera kupatsidwa chithandizo chogwira ntchito komanso chodalirika.
1.11. Ndikothekanso kukhazikitsa maluso omwe omwe amafunikira kwambiri amalandira chithandizo cha opaleshoni.
1.12. Zambiri zomwe zasonkhanitsidwa zikuwonetsa kuti opaleshoni kwa odwala omwe ali ndi kunenepa kwambiri ndi okwera mtengo.
1.13. Opaleshoni kwa odwala omwe ali ndi matenda a shuga a 2 ayenera kuchitika molingana ndi mfundo zovomerezeka, zonse kudziko lonse lapansi. Chifukwa chake, asanalowererepo, kuwunika kwa wodwalayo ndi zomwe akuyenera kuchita ziyenera kuchitika. Ndikofunikanso kukulitsa miyezo yapadziko lonse makamaka pochita opaleshoni ya bariatric pankhani ya odwala omwe ali ndi matenda a shuga 2 ndi BMI ya 35 ndi pamwambapa.
1.14. Opaleshoni ya Bariatric ali ndi chiwerengero chotsika cha kufa. Ziwerengerozi ndizofanana ndi zotsatira za opaleshoni ya ndulu.
1.15. Phindu la ma bariatric opaleshoni kwa anthu omwe ali ndi matenda a shuga a 2 amakhalanso ndikuthandizira kuchepetsa mwayi wamwalira pazifukwa zosiyanasiyana.
1.16. Ndikofunikira kupanga cholembera cha anthu omwe odwala adzalowe nawo atatha kulowererapo. Izi ndizofunikira kuti bungwe liziwasamalira moyenera komanso kuwunika kwambiri zotsatira za ntchito.

Maphunziro azachipatala.

Pakadali pano palibe mankhwala othandizira omwe angagwiritsidwe ntchito pochiritsa matenda a shuga a 2. Komabe, mwayi wambiri wa kuchiritsa kwathunthu umaperekedwa ndi opaleshoni ya metabolic mwanjira ya opaleshoni ya m'mimba ndi biliopancreatic bypass. Ntchito izi pakadali pano zimagwiritsidwa ntchito kwambiri popangira mankhwala oletsa kunenepa kwambiri. Monga mukudziwa, mwa odwala onenepa kwambiri, matenda a shuga a 2 amadziwika kwambiri ngati matenda a comorbid.Zinapezeka kuti kuchita ntchito ngati izi kumangotengera kulemera, komanso 80-98% ya milandu imachiritsa matenda ashuga okha. Izi zidakhala gawo loyambira kuphunzira kuti ngati angagwiritsidwe ntchito pochita opaleshoni ya metabolic pochizira kwambiri matenda ashuga amtundu wa 2 odwala omwe ali ndi kunenepa kwambiri, komanso ndi kulemera kwabwinobwino kapenanso kulemera kwamphamvu thupi (ndi BMI ya 25-30).

Kafukufuku wovuta akuchitika pokhudzana ndi makina a zochita za opaleshoni ya metabolic. Poyamba, zimaganiziridwa kuti kuchepa thupi ndiko kumatsogolera pakukula kwa glycemia. Komabe, zidadziwika kuti matenda a glycemia ndi glycated hemoglobin amapezeka nthawi yomweyo opaleshoni ya m'mimba kapena biliopancreatic bypass itachitidwa, ngakhale thupi lisanayambe kuchepa. Izi zidatipangitsa kufunafuna malongosoledwe ena pazotsatira zabwino za opaleshoni. Pakadali pano, akukhulupirira kuti njira yayikulu yogwirira ntchito ndi kuyimitsa duodenum kuchokera pachakudya. Pa opaleshoni ya m'mimba, chakudya chimatumizidwa mwachindunji kwa ileum. Mphamvu ya chakudya pa ileal mucosa imabweretsa chinsinsi cha glucagon-peptide-1 (GLP-1), chomwe chimanena za ma impretins. Peptide iyi ili ndi malo angapo. Zimathandizira kupanga insulini pamaso pamagulu a shuga. Zimathandizira kukula kwa maselo a beta mu kapamba (amadziwika kuti ndi matenda amtundu wa 2 pali vuto lowonjezereka la maselo a beta). Kubwezeretsedwanso kwa dziwe la beta ndichinthu chabwino kwambiri. GLP-1 imalepheretsa kupanga shuga kwa glucose mu chiwindi. GLP-1 imalimbikitsa kumverera kwodzaza ndi zolimbikitsa gawo loyenda la hypothalamus.

Maphunziro azachipatala.

Opaleshoni yam'mimba yokhala ndi mbiri yoposa zaka 50. Zotsatira zabwino za mtundu uwu wa opaleshoni ya metabolic panthawi ya matenda a shuga zatsimikiziridwa mobwerezabwereza ndi maphunziro angapo azachipatala omwe aphunzira zotsatira zazitali za ntchito zomwe cholinga chake chinali kuchepetsa kunenepa kwambiri kwa thupi. Zinawonetsedwa kuti chithandizo chokwanira cha matenda ashuga chimawonedwa mwa 85% ya odwala atachitidwa opaleshoni ya m'mimba ndipo mu 98% atachitidwa opaleshoni ya biliopancreatic bypass. Odwala awa adatha kusiyiratu mankhwala alionse omwe amamwa. Otsalira a 2-15% adawonetsa chidwi chambiri pakuchepetsa kwa mankhwala antidiabetes. Kafukufuku wazotsatira zomwe zakhala zikuchitika kwanthawi yayitali adawonetsa kuti anthu omwe amafa chifukwa cha zovuta zamatenda a shuga m'magulu momwe opaleshoni ya m'mimba idachitidwira anali 92% kutsika kuposa omwe anali mgululi pomwe othandizira adachitidwa.

Kafukufuku wachipatala adachitidwa momwe zotsatira za opaleshoni ya metabolic pamtundu wa 2 shuga adawerengera odwala omwe ali ndi thupi lozama komanso kupezeka kwa zolimbitsa thupi zolimbitsa thupi (zokhala ndi BMI yopitilira 30). Izi zidawerengera mokwanira zotsatira zabwino za kuchiritsa kwa 90% yamatenda a 2 omwe ali m'gulu ili la odwala komanso zothandiza mu 10% yotsala.

Zotsatira zofanananso ndi matenda a shuga 2 amtundu wa opaleshoni ya m'mimba atapezeka mwa achinyamata.

Ngati kuchuluka kwamthupi la wodwala yemwe ali ndi matenda ashuga ndi 35 kapena kuposerapo, opaleshoniyo imawerengedwa mosasamala.

Nthawi yomweyo, pomwe vutoli likukhudza odwala omwe ali ndi thupi labwinobwino kapena lochepa kwambiri, ndikofunikira kuwunika kuopsa kwa opaleshoni ndi zina zomwe zingakhale ndi zotsatirapo zabwino pochiza matenda ashuga. Poganizira kuti ngakhale kuchitira odwala mankhwala othandiza si njira yodalirika yotetezera matenda ashuga (matenda ashuga retinopathy, nephropathy, neuropathy ndi angiopathy ndiwowonekera pazotsatira zawo zazikulu), kugwiritsa ntchito opaleshoni ya metabolic kungakhale njira yodalirika yoperekera chithandizo ngakhale pagulu la odwala omwe ali ndi matenda a shuga a 2. .

Pakadali pano, akukhulupirira kuti opaleshoni ikuwonetsedwa kwa wodwala matenda a shuga a 2 omwe ali ndi BMI yochepera 35, ngati sangathe kulipidwa chifukwa cha matendawa ndi mankhwala amkamwa, ndiye muyenera kupita ku insulin. Popeza kutsogolera kwamatenda mwa wodwala yemwe ali ndi matenda a shuga 2 ndiko kutsutsana ndi insulini, ndipo sikuti akusowa insulin, kuikidwa kwina kwa insulin yowonjezera kumawoneka ngati kakamizidwe kovuta, sikuti komwe kumayambitsa matenda. Kumbali ina, kuchita ntchito ya shunt kumabweretsa kuchotsedwa kwa insulin kukakamira pamodzi ndi mawonekedwe a glycemia. Mwachitsanzo, mu Ballanthyne GH et al, mulingo wa kukana kwa insulini mu odwala asanachitike komanso atachitidwa opaleshoni ya m'mimba anaphunzitsidwa ndi njira yakale ya HOMA-IR. Zinawonetsedwa kuti mulingo wa HOMA musanachite opareshoni wokwanira 4.4 ndipo atachitidwa opaleshoni ya m'mimba unatsika pang'ono mpaka 1.4, womwe uli pakati pa mitundu yonse.

Gulu lachitatu lazomwe likuwonetsa ndi opaleshoni yodutsa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi BMI ya 23-35 omwe samalandira insulin. Gulu la odwala pano ndi gulu lofufuzira. Pali odwala omwe ali ndi vuto lozolowereka kapena lokwera pang'ono lomwe akufuna kuthetsa vuto la matenda awo a shuga kwambiri. Amaphatikizidwa m'maphunziro ngati amenewa. Zotsatirazo ndizolimbikitsa kwambiri - chikhululukiro chachipatala komanso chidziwitso cha matenda a shuga m'gululi chimatheka mwa onse odwala.

Kufunika kwa opaleshoni ya metabolic pochiza odwala omwe ali ndi matenda a shuga 2

Choyamba, opaleshoni ya metabolic imakhala ndi gawo lalikulu pothandizira odwala omwe ali ndi matenda a shuga a 2. Matendawa ndivuto lazachipatala, zachikhalidwe komanso zachuma kwa anthu. Imafalikira padziko lonse lapansi, imapereka zovuta kwambiri, imayambitsa kulumala kwakukulu ndi kufa.

Pakadali pano, njira zochizira sizikudziwika pochiritsa odwala matenda a shuga a 2. Komabe, njira zopangira opaleshoni ya metabolic monga gastric ndi biliopancreatic bypass opaleshoni zimapereka mwayi wabwino wowachiritsa anthu omwe ali ndi matendawa. Njira izi zikugwiritsidwa ntchito kwambiri pochiza odwala onenepa kwambiri. Mwa anthu awa, matenda a shuga a mtundu II ndiofala kwambiri.

Zinapezeka kuti pambuyo opaleshoniyo osati okhawo kulemera, koma 90% ya matenda a shuga mellitus amachiritsidwa. Izi zidakhala gawo loyambitsa maphunziro omwe amafotokoza ngati opaleshoni ya metabolic ingagwiritsidwe ntchito pochiza matenda osokoneza bongo a 2 osati odwala onenepa okha, komanso kwa omwe ali ndi vuto labwino kapena olimbitsa thupi (index kulemera kwa thupi sikupitirira 25).

Momwe opaleshoni ya metabolic imagwirira ntchito

Pali malingaliro osiyanasiyana okhudza zochita za opaleshoni ya metabolic. Poyamba, akatswiri amakhulupirira kuti makina otsogola mu kuchuluka kwa shuga m'magazi ndi kuchepa kwa thupi. Pakapita kanthawi, zinapezeka kuti kuchuluka kwa glucose ndi hemoglobin komwe kumalumikizidwa ndi nthawi yomweyo pambuyo pa kugwiritsidwa ntchito kwa shun.

Mkuyu. Mini m'mimba
1 - esophagus, 2 - m'mimba yaying'ono,
4 - m'mimba mwake panagundika chimbudzi,
5 - m'chiuno chaching'ono chitakhazikika pamimba yaying'ono,
6 - msambo womaliza wamatumbo ang'ono

Pakadali pano, njira yayikulu yogwirira ntchito ndi kutsekeka kwa duodenum kuti isunthe chakudya. Pambuyo pakuchita opaleshoni ya m'mimba, zomwe zili m'mimba zimatumizidwa mwachindunji kwa ileum. Chakudya chimakhudza mosiyanasiyana mucous nembanemba wa matumbo amenewa, omwe amatsogolera pakupanga chinthu chapadera chomwe chimapangitsa kuphatikizira kwa insulin pamaso pa kuchuluka kwa glucose. Zimathandizanso kukula kwa maselo a pancreatic omwe amapanga insulin. Kubwezeretsa chiwerengero chawo kuli ndi phindu pa mkhalidwe wa metabolism ya carbohydrate.

Izi zimathandizira kupanga shuga m'magazi a chiwindi, imayendetsa mtima wa hypothalamus, womwe umayambitsa machulukidwe. Chifukwa cha izi, kumverera kwodzaza kumadza mwachangu pambuyo kudya zakudya zochepa.