Everyone is looking forward to getting rid of the dilemma of "hey, that fat man" through it.
But at the thought of having an operation, I was worried about 10000.
So, can we operate or not?
Maybe you want to know this before you make a decision.
People who have severe metabolic syndrome and are unable to exercise to lose weight, which seriously affects the quality of life and life safety.
The Center for Weight Loss and Metabolic Surgery in our hospital once contacted a patient who died suddenly in his sleep because of sleep apnea syndrome and delayed treatment after consulting weight loss and metabolic surgery. Because the patient's blood oxygen concentration is low, the dean asked the case manager to call the patient's family several times to suggest advanced respiratory department, which led to a regrettable ending.
In addition, patients also need to meet some conditions:
? The age is between 16 and 65 years old.
? Body mass index ≥27.5kg/㎡
? The course of type 2 diabetes is ≤ 15 years, and the islet still has certain insulin secretion function, and the fasting serum C-peptide level is ≥ 1/2 of the normal lower limit.
Body mass index body mass index
Body mass index is an important index to reflect obesity.
It is also the main indication of whether patients with type 2 diabetes and obese patients are suitable for metabolic surgery.
Body mass index = weight kg ÷ height m ÷ height m
For example, a person's weight is 50kg and his height is1.6m.
Ta's body mass index = 50 ÷1.6 ÷1.6 =19.53kg/m2.
C peptide? C peptide
C-peptide is mainly used to evaluate islet function.
C-peptide is secreted by islet β cells, which can accurately evaluate the secretory function of islet β cells. The purpose of evaluating islet function is to relieve or cure diabetes through metabolic surgery, which requires patients to have certain islet function.
For fasting serum C-peptide, it is generally required to be more than half of the lower limit of normal value. After taking sugar for 60 minutes in oral glucose tolerance test, the level of C-peptide rises to more than twice the basic level.
The duration of DM? Course of diabetes mellitus
For the course of diabetes, type 2 diabetes is generally required to be within 15 years; Generally speaking, the shorter the course of disease, the lighter the damage of islet function and the better the surgical effect.
In addition, doctors need to understand the effects of obesity and metabolic diseases on patients and the severity of type 2 diabetes through various examinations, and make an assessment, so as to make a preoperative preparation plan.
1.？ routine examination
(1) Blood type, blood routine, urine routine, stool routine.
(2) Screening of blood sugar, electrolyte, liver function, renal function, coagulation function, blood lipid, tumor markers and infectious diseases (hepatitis B, hepatitis C, AIDS, syphilis, etc.). ).
(3) Electrocardiogram: To know whether there are any abnormalities such as arrhythmia and myocardial infarction.
(4) Chest X-ray examination: to find out whether there is lung infection, chronic obstructive pulmonary disease, heart enlargement, etc.
2. Endoscopic examination
Gastroscopy is a necessary examination item, which can directly observe the size and scope of the stomach and determine whether there are lesions such as ulcers in the stomach. If the patient has Helicobacter pylori infection, he should be treated before operation.
3. Image inspection
(1) Ultrasound examination: To know whether the patient's liver, gallbladder, pancreas, adrenal gland, kidney, abdominal cavity and pelvic cavity (including women's ovary and uterus) are complicated with other diseases, whether there is thrombosis after color Doppler ultrasound of arteriovenous vessels of both lower limbs, and whether they can tolerate surgery.
(2) Considering the secondary obesity caused by pituitary adenoma, pituitary magnetic resonance imaging (MRI) can be performed.
(3) Body composition analysis: Determine the proportion of fat in different parts of the body.
4. Other inspections
(1) Examination of tumor markers: CEA, AFP, etc.
(2) Nutritional risk screening and nutritional assessment: judging whether there is nutritional risk or malnutrition.
(3) Obese patients with type 2 diabetes should also do OGTT glucose tolerance test, glycosylated hemoglobin determination, fasting and postprandial insulin and C-peptide function.
(4) For long-term smokers and patients with chronic lung diseases, pulmonary function examination, color Doppler echocardiography and left ventricular function measurement are needed to evaluate the tolerance of surgery.
Generally speaking, patients' tolerance to surgery can be divided into two categories:
1.？ Good tolerance: obesity and metabolic diseases have little influence on the whole body or are easy to correct, and patients without accompanying diseases or compensation of important organ functions only need routine preoperative preparation;
2. Intolerance: Obesity and metabolic diseases have obvious effects on the whole body, or diseases such as type 2 diabetes seriously affect the functional compensation of important organs. This kind of patients need careful preoperative preparation to correct all kinds of organ dysfunction that have occurred. Only after the general situation improves can they have a higher success rate and a lower incidence of complications.
After a detailed preoperative examination, the doctor can choose the appropriate operation for you according to your situation.
1.？ What is the operation process? How many days can I leave the hospital after operation?
Weight-loss surgery is a minimally invasive surgical technique, which has the advantages of less trauma and quick recovery, and requires hospitalization for 3~7 days after surgery. Many patients are very afraid of surgery and think that as long as there is the word "surgery", they need to insert a drainage tube, stay in bed and be taken care of by their families.
In fact, the most important thing is to choose a hospital and a team of doctors with rich experience in weight-loss metabolic surgery, so that the management system from doctor's surgery to postoperative is very mature, and the operation time is short. The patient can get out of bed on the day after surgery without inserting various drainage tubes, and the patient has no imagined pain after surgery.
2. Is the operation risky?
Surgery, of course, is bound to be risky.
Metabolic surgery for weight loss is a mature surgery. With the progress of technology, the increase of surgical experience and the improvement of preoperative, intraoperative and postoperative nursing, the overall safety of metabolic surgery to lose weight has also been greatly improved. The risk you need to take in a weight-loss metabolic surgery is similar to (even lower than) some ordinary operations around us.
Among obese people, the risk of death of patients without surgery is 8 times higher than that of patients with weight loss and metabolic surgery; The relative death risk of patients undergoing weight-loss metabolic surgery is 89% lower than that of patients not undergoing surgery. The risk of weight loss metabolic surgery is lower than that of laparoscopic cholecystectomy, and its risk is relatively low.
Everyone faces different surgical risks, and the doctor will give advice or corresponding measures according to your specific situation.
3. Will bariatric surgery rebound?
For the treatment of severe obesity, bariatric surgery is the only effective long-term treatment.
Everyone's body has a fine detection and regulation system, which can control the energy balance of the body, and short-term weight gain or loss will be automatically compensated, which is why after normal weight loss, the weight still tends to return to the set point level.
After setting the "set point", when the intake of the body increases, the "set point" can increase the metabolic rate and consumption of the body; When the weight drops, the "set point" can reduce the metabolic rate and consumption of the body, so as to stabilize the weight in a certain range.
It is generally believed that if the heat remains high for a long time. High-fat diet will increase the regulatory point, and this increase is irreversible, while obese people have a higher level of regulatory point. This theory seems to explain why it is difficult for most obese people to lose weight, or it is difficult to maintain it for a long time even after losing weight.
After weight loss surgery, due to the changes of gastrointestinal hormones, the body fat adjustment point will be reduced to the ideal level, and then the metabolic state of the body will be adjusted accordingly to achieve a new body fat ratio. Therefore, the change of gastrointestinal hormones is an important factor to maintain the long-term effectiveness of bariatric surgery.
4. How long will the blood sugar return to normal after the operation?
The recovery time is relatively different according to the different diabetic status and surgical methods of different patients. For patients who recover quickly, blood sugar will drop three to five days after operation, not only blood sugar will drop, but also blood pressure will drop, and many metabolic indicators will gradually improve. There are still some patients whose blood sugar gradually drops after one month, and it takes two months, three months or even longer for their blood sugar to return to the ideal state. Compared with traditional drug therapy and insulin injection to keep blood sugar stable, surgical treatment of type 2 diabetes is a medical breakthrough.
5. Can weight loss surgery be reimbursed? How much will it cost?
Metabolic surgery for weight loss due to simple obesity is not reimbursed by public hospitals or private hospitals. Obesity complicated with metabolic syndrome can be reimbursed, and the reimbursement ratio can be consulted with the local rural cooperative medical insurance bureau.
The cost of different surgical methods in different weight-loss metabolic treatment centers in China is also different, which is about 50,000-80,000 (the data mainly comes from the feedback of patients and friends consulted, and friends are subject to the hospital).
Metabolic surgery for weight loss is not as expensive as possible. Doctors will refer to clinical standards and patient indicators, choose appropriate surgery for patients, and provide treatment programs. However, disposable consumables account for a large proportion of the cost of bariatric surgery. Too cheap surgery also needs to pay attention to distinguish whether it is formal, choose hospitals and doctors with more advanced technology and more experience, and have scientific surgery and follow-up cases supported by relevant literature at home and abroad.
Finally, the completion of weight loss metabolic surgery is not once and for all, and postoperative health management is also very important. Therefore, after weight-loss surgery, patients need to go to the hospital for reexamination frequently, and recheck once every 1 month, 3 months, 6 months and 1 year after surgery, and make corresponding adjustments according to their actual situation to ensure the effect of weight-loss surgery to the greatest extent.