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国外糖尿病手术的发展现况第1页/共41页会计学第2页/共41页由减重手术到糖尿病手术以减重手术治疗糖尿病胃肠道代谢手术 (Gastro-intestinal Metabolic surgery)病人的选择第3页/共41页减重手术在美国已是最常见的胃肠道手术Nature 2000; 404, 635 - 43第4页/共41页Obesity Co-morbiditiesMetabolicMechanical.Obstructive Sleep Apnea.Hypoventilation Syndrome.Osteoarthritis.Stasis Dermatitis.Heart Failure.Incontinence.Quality of Life .Diabetes.Cardiovascular.Gall stone.NASH.Gout.Cancer.PCOSPsycho-Social. Psychologic：Loss self-confidenceSocial:FreindMarriageJob, Promotion生命不可承受之重Unbearable weight in life第5页/共41页BMI与死亡率的关系Mortality lowest at 22.5-2530% higher at each 5 BMI higher40% vascular60-120% DM, renal and hepatic10% MalignancyJAMA 1999Lancet. 2009 March 28; 373(9669):1083-1096第6页/共41页减重手术是严重肥胖最有效的治疗方法Effect of Bariatric Surgery on Mortality in Swedish Obese SubjectsLars Sjostrom et al. N Eng