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糖尿病
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=== 手术治疗 === 针对肥胖相关的2型糖尿病,'''减重代谢手术'''(俗称“糖尿病手术”)作为一种治疗手段在近年受到重视。减重手术包括胃旁路术、袖状胃切除术等,通过缩小胃容量和/或绕过部分小肠,促使体重大幅下降并带来一系列代谢改善。对于符合适应证的肥胖2型糖尿病患者,手术后血糖控制往往显著改善,有相当比例的患者可实现糖尿病的部分缓解甚至临床缓解(停止药物仍保持正常血糖) (代谢手术:在长期有效性与安全性之间寻找最佳平衡点)。研究表明,与单纯药物和生活方式干预相比,减重手术在降低糖化血红蛋白、减少降糖药物依赖方面效果更为显著,许多患者术后多年内保持血糖正常 (代谢手术:在长期有效性与安全性之间寻找最佳平衡点)。因此,国际糖尿病协会和肥胖协会建议,对于BMI达到一定阈值(如东亚人群BMI≥27.5或≥32,西方标准BMI≥35)且血糖控制不佳的2型糖尿病患者,可考虑代谢手术作为综合治疗的一部分。需要多学科评估患者手术指征及风险。减重代谢手术除控制血糖外,对改善高血压、睡眠呼吸暂停等合并症也有积极作用。当然,手术本身存在一定风险,术后患者仍需配合饮食、运动以及定期随访管理,以维持疗效和监测营养状况。总体而言,代谢手术为肥胖2型糖尿病患者提供了一种潜在的“治愈”途径,有望减少长期并发症和死亡风险 (代谢手术:在长期有效性与安全性之间寻找最佳平衡点)。
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