Initial pioneering is difficult, but growth is fast
Laparoscopic gastric bypass is the main representative of metabolic disease surgery, which can effectively treat obesity and type 2 diabetes, and the effect of the surgery is mainly through the hormone secretion in the body to realize. The principle of the surgery is that, on the one hand, food can be kept from passing through the duodenum and the upper jejunum, leading to a decrease in the secretion of a certain hormone that resists (inhibits) insulin function; on the other hand, the under-digested food can be made to reach the terminal ileum too quickly, leading to an increase in insulin secretion, and thus to a decrease in blood glucose. If the patient is also obese, the efficacy of insulin can also be improved by reducing fat cells, lowering blood glucose. The surgery is minimally invasive, with only small puncture holes in the abdominal wall and no incisions, resulting in less trauma, less pain, and quicker recovery, and patients are usually able to get out of bed the same day.
Looking back at the development of metabolic disease surgery in China over the past 10 years, there are three main characteristics: 1. Difficulty in pioneering at the initial stage, and fast growth and explosion. 2. Strong imitation ability, and less innovation and pioneering. 3. High level of operation, and less detailed research. Due to the differences in concepts and technologies, only a few doctors in the industry were performing metabolic surgery in the first few years. Due to the good therapeutic effect, this difficult exploration was finally persisted. in November 2007, in the Chinese Medical Association Diabetes Branch National Academic Conference, this surgical method was recognized. in October 2009, the American Diabetes Association (ADA) annual meeting for the first time, surgical treatment of diabetes mellitus as a form of diabetes treatment, included in the expert **** knowledge. 5 months later, the International Diabetes Federation also issued a statement that gastric bypass surgery is one of the measures for the treatment of type 2 diabetes, recommending that patients who meet the indications for surgery take early surgical treatment to prevent possible complications. 2010, the Chinese version of the guidelines for the prevention and treatment of diabetes for the first time included gastric bypass surgery.
With the international and domestic industry's recognition of surgery for diabetes, the previous situation, in which only individual hospitals and individual doctors carried out the surgery, has been reversed, and a number of medical institutions have been carrying out related surgeries one after another. According to incomplete statistics, more than dozens of medical institutions in cities such as Beijing, Shanghai, Guangzhou and Nanjing are now carrying out related surgeries, and many more hospitals are preparing to do so.
Profit-seekers stirring up complications
As patients have demand, various medical institutions seem to see the huge benefits of this, and tend to rush. For some time, a search on the Internet for the keywords "weight loss surgery" or "diabetes surgery" brought up advertisements from almost all small hospitals and even individual clinics.
Because of the blind pursuit of the trend, resulting in the emergence of surgical chaos. Some people will not use laparoscopy, open abdomen to do; standardized gastrointestinal bypass surgery is too difficult to do, do the general gastric resection surgery; not dare to do to the fat people, pick the skinny people; there is no type 2 diabetic patients, the type 1 patients came to do. Due to some medical institutions management is not standardized, engaged in the operation of the personnel and team is very mixed, surgical indications grasp is not strict, the emergence of a number of surgical complications, and even deaths. 2012 was due to individual operators and medical institutions of non-standard operation, by the former Ministry of Health to question. In the end, experts engaged in metabolic disease research by analyzing the development situation at home and abroad and the current situation, and actively fight, finally regained support, the operation was retained.
For a medical technology to be on the track of benign development, the indications must be strictly grasped. There are three indications for metabolic disease surgery: first, obese type 2 diabetic patients, type 1 diabetes is a contraindication. Second, the age should be less than 65 years old and the medical history less than 15 years. Third, islet function is in the compensatory phase. Only when the above three conditions are met at the same time is surgical treatment suitable. People with advanced diabetes, pancreatic islet failure, severe organic diseases that cannot tolerate surgery, intestinal dysfunction, moderate-to-severe diabetic gastroparesis, people with severe complications, and patients with autoimmune diabetes are not suitable for this surgical treatment. Strict grasp of the indications for surgery, standardized preoperative examination, perioperative evaluation of the patient, surgical operation and postoperative complication management, and postoperative follow-up are the guarantee for the safety and effectiveness of diabetes surgical treatment.
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