Бариатрический пациент: основные аспекты подготовки к хирургическому лечению ожирения и ведения после него. Лекция для практических врачей

Ершова Е.В., Комшилова К.А., Мазурина Н.В., Трошина Е.А. Бариатрический пациент: основные аспекты подготовки к хирургическому лечению ожирения и ведения после него. Лекция для практических врачей. Consilium Medicum. 2021; 23 (4): 339–346. DOI: 10.26442/20751753.2021.4.200831

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Ershova EV, Komshilova KA, Mazurina NV, Troshina EA. The bariatric patient: basic aspects preparation for surgical treatment of obesity and conducting after it. Lecture for practitioners. Consilium Medicum. 2021; 23 (4): 339–346. DOI: 10.26442/20751753.2021.4.200831

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Аннотация

На протяжении последних лет и десятилетий во всем мире в целом и в России в частности для лечения тяжелых форм ожирения бариатрическая хирургия получает все более широкое распространение, при этом наблюдается как увеличение количества выполняемых операций, так и накопление опыта в отношении их безопасности и эффективности, а также совершенствование хирургических методик. В данной лекции четко обозначены показания и противопоказания к хирургическому лечению ожирения. Описаны различные виды бариатрических операций и патофизиологические механизмы их влияния на массу тела, углеводный и липидный обмен, а также продемонстрирована их эффективность при коморбидной ожирению патологии, в первую очередь у пациентов с сахарным диабетом 2-го типа (СД 2). Продемонстрированы требования к бариатрическим операциям и приведены параметры оценки их эффективности, в том числе ремиссии СД 2. Проанализированы возможные осложнения хирургических методов лечения ожирения, в том числе вторичный гиперпаратиреоз, постбариатрические гипогликемии и другие, а также предикторы послеоперационного прогноза в отношении метаболического контроля у пациентов с ожирением и СД 2.

Ключевые слова: ожирение, сахарный диабет 2-го типа, бариатрические операции

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Over the past years and decades, in the world in general and particularly in Russia, bariatric surgery is becoming more widespread for the treatment of severe forms of obesity. There is an increase in the number of operations performed along with the effectiveness and minimising risks of the operations held due to the improvement of surgical techniques. In this lecture, there are clearly stated indications and contraindications for the surgical treatment of obesity. Here are presented various types of bariatric surgeries and their pathophysiological mechanisms which affect on body weight, carbohydrate and lipid metabolism. There is also presented their effectiveness in comorbid obesity pathology, primarily among patients with type 2 diabetes. Here was held an analysis of possible negative effects after surgical treatment for obesity, including secondary hyperparathyroidism, post-bariatric hypoglycemia, etc., as well as predictors of postoperative prognosis in relation on metabolic control among patients with obesity and type 2 diabetes.

Keywords: obesity, type 2 diabetes mellitus, bariatric surgery

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Авторы

Е.В. Ершова*, К.А. Комшилова, Н.В. Мазурина, Е.А. Трошина

ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
*yu99pol06@rambler.ru

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Ekaterina V. Ershova*, Kseniya A. Komshilova, Natalya V. Mazurina, Ekaterina A. Troshina

Endocrinology Research Centre, Moscow, Russia
*yu99pol06@rambler.ru

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