公佈播道醫院縮胃手術治療二型糖尿病中期研究結果及 國際糖尿病聯盟利用手術治療二型糖尿病最新指引
本港約有十分一人口患有二型糖尿病，大部份患者更有過重或肥胖的問題。改變生活模式及藥物治療是醫治糖尿病的主要方法，唯部分患者對治療的依從性較差。據統計高達三分二的病人血糖控制未能達標，增加了糖尿病併發症的風險。
腹腔鏡縮胃手術自2005年引入亞洲，至今已成為區內減重手術的黃金標準，用作治療病態肥胖症。縮胃手術的原理是利用腹腔鏡把胃的大彎垂直切割出來，使胃部形成一個約150亳升的長型小胃囊，另外還會使刺激胃口的荷爾蒙(Ghrelin)分泌減少，減低食慾和食量。此手術的減重成效顯著，術後兩年內約可減七成的多餘體重。近年縮胃手術及此類手術更被證實除有效減重外更會增加胰高血糖素（GLP-1），對某些病人有特別治療和預防二型糖尿病之效果。近日國際糖尿病聯盟(IDF)首次訂下利用此類手術治療亞洲二型糖尿病指引，如下:
- 二型糖尿病及體重指數（BMI）>32.5病人應考慮接受手術治療。
- 二型糖尿病及體重指數（BMI）>27.5病人可考慮接受手術治療尤其是糖尿病不能以傳統方法控制（HBA1c>7.5％）。
- 手術治療二型糖尿病是輔助治療，不應視作取代傳統內科治療的方法。
自2009年播道醫院與確進糖尿及內分泌專科中心合作，集合不同專科醫護人員為合適糖尿病人提供外科手術治療及進行研究。研究結果顯示，香港首36位糖尿病人接受縮胃手術跟進三年後，高達55％病人糖尿病完全痊癒。
Report on the use of laparoscopic sleeve gastrectomy at Evangel Hospital for Type II diabetes mellitus and the latest International Diabetes Federation’s recommendations
In Hong Kong, it is estimated that one tenth of the population is suffering from Type II diabetes mellitus (DM), and majority of them are either overweight or obese. While life-style modification and medical therapy is the cornerstone in the management Type II DM, remission of the disease is rarely seen. In a significant proportion of patients (2/3), their compliance to therapy is poor, and the control of Type II DM is far from ideal with increased risks of diabetic complications.
Since its introduction in Asia in 2005, Laparoscopic sleeve gastrectomy (LSG) is becoming the gold standard treatment of obesity in the district. It is a minimally invasive surgical intervention originally designed for the treatment of morbid obesity. It generates weight loss by removing the greater curve of stomach (creating a 150 cc longitudinal gastric reservoir) and diminishing the production of appetite hormone (Ghrelin). The outcome of LSG is apparent and very encouraging with a reported excess body weight loss of 70% in two-year period after surgery in most studies. Recent researches confirmed that in addition to the weight-loss effect, LSG and other similar bariatric gastrointestinal surgery can significantly increase level of incretin (GLP-1) after surgery, which is very beneficial in treating and preventing Type II DM in selected patients. The International Diabetes Federation (IDF) has recently laid down the recommendations of using these kinds of surgical intervention in the treatment of Type II DM in Asia population and are as follows:
- Surgery should be recommended as an appropriate treatment for people with Type II DM with body mass index (BMI) >32.5.
- Surgery may be considered as an appropriate treatment for people with Type II DM with BMI >27.5 not achieving recommended treatment target (HbA1c>7.5%) with medical therapies.
- Surgery should be considered as a complementary to medical therapies.
With a joint collaboration of specialists from the Evangel Hospital and Qualigenics Diabetes Centre, the first series of LSG in treating Type II DM in Hong Kong was completed. A total of 38 patients had been studied and 51.5 % of patientis were in complete remission after 3-year follow up.
Information provided by Evangel Hospital | 以上資訊由播道醫院提供
