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Nutukimas

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Edgaras Kulikauskas
Edgaras Kulikauskas

Obesity in Lithuania

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Nutukimo Chirurginis gydymas Edgaras Kulikauskas Vilniaus universiteto Santari邸ki迭 klinikos Pilvo chirurgijos centras
Kas yra Nutukimas?
KMI > 30
Nutukimas
NUTUKIMAS YRA VISUR
Kaip atsiranda nutukimas?
Nutukimas
Energijos tverms dsnis!
Gauna ma daugiau Naudoja ma ma転iau
Nutukimas
ANT svoris 3 i邸 4 眺 1 i邸 2
KMI > 30
KMI > 30
KMI > 30
KMI > 30
KMI > 30
KMI > 30
KMI > 30
KMI > 30
KMI > 30
1 i邸 2 KMI > 25 1 i邸 5 KMI > 30
Nutukimo komplikacijos
閣転霞壊 Hiper Cukrinis diabetas tenzija NUTUKIMAS Dislipid emija Koronarin 邸irdies liga
Nutukimas
Nutukimas
Nutukimas
Kuris Kelias?
Dieta?
Nutukimas
Nutukimas
Vaistai?
Nutukimas
3-5% Medical Therapy for Obesity George A. Bray, MD, MACP MOUNT SINAI JOURNAL OF MEDICINE 77:407417, 2010
Sibutraminas Lietuvoje ir EU 顎転糸姻温顎壊岳温壊
Chirurgija ?
KMI > 40
KMI > 35 + gretutins ligos
KMI > 50
800%
restrikcins operacijos
apylankos operacijos
mi邸rios operacijos
Nutukimas
Nutukimas
Nutukimas
Nutukimas
From: Bariatric Surgery and Long-term Cardiovascular Events . 2012;307(1):56-65. doi:10.1001/jama.2011.1914 Figure Legend: Data shown for controls obtaining usual care and for surgery patients obtaining banding, vertical banded gastroplasty, or gastric bypass at baseline. Percentage weight changes from the baseline examination and onward are based on data available on July 1, 2011. Error bars represent 95% CIs. Copyright 息 2012 American Medical Date of download: 11/8/2012 Association. All rights reserved.
Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus, Philip R Schauer, MD,* Bartolome Burguera, MD, Sayeed Ikramuddin, MD, Dan Cottam, MD,* William Gourash, CRNP,* Giselle Hamad, MD,* George M. Eid, MD,* Samer Mattar, MD,* Ramesh Ramanathan, MD,* Emma Barinas-Mitchel, PhD, R. Harsha Rao, MD, Lewis Kuller, MD DrPH, and David Kelley, MD. Ann Surg. 2003 October; 238(4): 467485
Nutukimas
Philip R. Schauer, M.D., Sangeeta R. Kashyap, M.D., Kathy Wolski, M.P.H., Stacy A. Brethauer, M.D., John P. Kirwan, Ph.D., Claire E. Pothier, M.P.H., Susan Thomas, R.N., Beth Abood, R.N., Steven E. Nissen, M.D., and Deepak L. Bhatt, M.D., M.P.H.Bariatric Surgery vs. Intensive Medical Therapy in Obese Patients with Diabetes. This article (10.1056/NEJMoa1200225) was published on March 26, 2012, at NEJM.org.
Metforminas Insulinas VISI VISI VISI 65% 64% 27% 21% 13% 13% 23% 6% Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus, Philip R Schauer, MD,* Bartolome Burguera, MD, Sayeed Ikramuddin, MD, Dan Cottam, MD,* William Gourash, CRNP,* Giselle Hamad, MD,* George M. Eid, MD,* Samer Mattar, MD,* Ramesh Ramanathan, MD,* Emma Barinas-Mitchel, PhD, R. Harsha Rao, MD, Lewis Kuller, MD DrPH, and David Kelley, MD. Ann Surg. 2003 October; 238(4): 467485
40% nebereikia vartoti antihipertenzini迭 vaist迭
Lars Sj旦str旦m, Anders Gummesson, C David Sj旦str旦m, Kristina Narbro, Markku Peltonen, Hans Wedel, Calle Bengtsson, Claude Bouchard,Bj旦rn Carlsson, Sven Dahlgren, Peter Jacobson, Kristjan Karason, Jan Karlsson, Bo Larsson, Anna-Karin Lindroos, Hans L旦nroth, Ingmar N辰slund, Torsten Olbers, Kaj Stenl旦f, Jarl Torgerson, Lena M S Carlsson, for the Swedish Obese Subjects Study. Eff ects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol 2009; 10: 65362 Published Online June 24, 2009 DOI:10.1016/S1470- 2045(09)70159-7
Operacij迭 komplikacijos
Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity (Review). This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 2
Skrand転io apylanka Skrand転io apjuosimas Gastrojejunostomos strikt笛ra 的min ki邸ens obstrukcija (0- (2-3%). 10%) Kra邸tinis i邸opjimas (3-5%) Juostos protr笛zija (7%) Tul転ies p笛sls akmenlig (2%) Tul転ies p笛sls akmenlig (2%) Vidin i邸var転a su obstrukcija Rezervuaro oinfekcija (0,3-9%) (0-5%) Dampingo sindromas (0-10%) Nuostos nusmukimas (2-14%) Rezervuaro ar dreno bloga funkcija (0,4-7%) Refliuksas ar stempls diliatacija (0-10%) Psichologinis netoleravimas (0-5%) Vlyvos reoperacijos (5-10%) Vlyvos reoperacijos (iki 50%)
Stamb笛s kaulai?
Nutukimas
Ai笛 u転 dmes眺

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Nutukimas

  • 1. Nutukimo Chirurginis gydymas Edgaras Kulikauskas Vilniaus universiteto Santari邸ki迭 klinikos Pilvo chirurgijos centras
  • 3. KMI > 30
  • 6. Kaip atsiranda nutukimas?
  • 9. Gauna ma daugiau Naudoja ma ma転iau
  • 11. ANT svoris 3 i邸 4 眺 1 i邸 2
  • 21. 1 i邸 2 KMI > 25 1 i邸 5 KMI > 30
  • 23. 閣転霞壊 Hiper Cukrinis diabetas tenzija NUTUKIMAS Dislipid emija Koronarin 邸irdies liga
  • 33. 3-5% Medical Therapy for Obesity George A. Bray, MD, MACP MOUNT SINAI JOURNAL OF MEDICINE 77:407417, 2010
  • 34. Sibutraminas Lietuvoje ir EU 顎転糸姻温顎壊岳温壊
  • 36. KMI > 40
  • 37. KMI > 35 + gretutins ligos
  • 38. KMI > 50
  • 39. 800%
  • 47. From: Bariatric Surgery and Long-term Cardiovascular Events . 2012;307(1):56-65. doi:10.1001/jama.2011.1914 Figure Legend: Data shown for controls obtaining usual care and for surgery patients obtaining banding, vertical banded gastroplasty, or gastric bypass at baseline. Percentage weight changes from the baseline examination and onward are based on data available on July 1, 2011. Error bars represent 95% CIs. Copyright 息 2012 American Medical Date of download: 11/8/2012 Association. All rights reserved.
  • 48. Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus, Philip R Schauer, MD,* Bartolome Burguera, MD, Sayeed Ikramuddin, MD, Dan Cottam, MD,* William Gourash, CRNP,* Giselle Hamad, MD,* George M. Eid, MD,* Samer Mattar, MD,* Ramesh Ramanathan, MD,* Emma Barinas-Mitchel, PhD, R. Harsha Rao, MD, Lewis Kuller, MD DrPH, and David Kelley, MD. Ann Surg. 2003 October; 238(4): 467485
  • 50. Philip R. Schauer, M.D., Sangeeta R. Kashyap, M.D., Kathy Wolski, M.P.H., Stacy A. Brethauer, M.D., John P. Kirwan, Ph.D., Claire E. Pothier, M.P.H., Susan Thomas, R.N., Beth Abood, R.N., Steven E. Nissen, M.D., and Deepak L. Bhatt, M.D., M.P.H.Bariatric Surgery vs. Intensive Medical Therapy in Obese Patients with Diabetes. This article (10.1056/NEJMoa1200225) was published on March 26, 2012, at NEJM.org.
  • 51. Metforminas Insulinas VISI VISI VISI 65% 64% 27% 21% 13% 13% 23% 6% Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus, Philip R Schauer, MD,* Bartolome Burguera, MD, Sayeed Ikramuddin, MD, Dan Cottam, MD,* William Gourash, CRNP,* Giselle Hamad, MD,* George M. Eid, MD,* Samer Mattar, MD,* Ramesh Ramanathan, MD,* Emma Barinas-Mitchel, PhD, R. Harsha Rao, MD, Lewis Kuller, MD DrPH, and David Kelley, MD. Ann Surg. 2003 October; 238(4): 467485
  • 52. 40% nebereikia vartoti antihipertenzini迭 vaist迭
  • 53. Lars Sj旦str旦m, Anders Gummesson, C David Sj旦str旦m, Kristina Narbro, Markku Peltonen, Hans Wedel, Calle Bengtsson, Claude Bouchard,Bj旦rn Carlsson, Sven Dahlgren, Peter Jacobson, Kristjan Karason, Jan Karlsson, Bo Larsson, Anna-Karin Lindroos, Hans L旦nroth, Ingmar N辰slund, Torsten Olbers, Kaj Stenl旦f, Jarl Torgerson, Lena M S Carlsson, for the Swedish Obese Subjects Study. Eff ects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol 2009; 10: 65362 Published Online June 24, 2009 DOI:10.1016/S1470- 2045(09)70159-7
  • 55. Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity (Review). This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 2
  • 56. Skrand転io apylanka Skrand転io apjuosimas Gastrojejunostomos strikt笛ra 的min ki邸ens obstrukcija (0- (2-3%). 10%) Kra邸tinis i邸opjimas (3-5%) Juostos protr笛zija (7%) Tul転ies p笛sls akmenlig (2%) Tul転ies p笛sls akmenlig (2%) Vidin i邸var転a su obstrukcija Rezervuaro oinfekcija (0,3-9%) (0-5%) Dampingo sindromas (0-10%) Nuostos nusmukimas (2-14%) Rezervuaro ar dreno bloga funkcija (0,4-7%) Refliuksas ar stempls diliatacija (0-10%) Psichologinis netoleravimas (0-5%) Vlyvos reoperacijos (5-10%) Vlyvos reoperacijos (iki 50%)