surgeons-standing-in-operation-room_1170-2208.jpg

首先要聲明的是 
這些指引(guideline)並不是醫療行為的金科玉律 
而是醫師執行醫療業務時的參考 
也是我與個案討論治療方針的基礎 

有時候(或者是常常)在臨床上也會有指引外的例外情形 
而且指引本身也會隨著醫學證據的進展 
逐漸修正 
請各位有興趣的朋友 
要特別注意這一點 
不要把指引做為不可打破的定律 

為了保留原文的含意 我在此特別引用原文 (參考資料)
再加上自己的翻譯 
以便中英文參照 

1. Metabolic surgery should be recommended to treat type 2 diabetes in appropriate surgical candidates with
BMI >40 kg/m2 (BMI >37.5 kg/m2 in Asian Americans), regardless of the level of glycemic control or complexity
of glucose-lowering regimens, and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian Americans) when hyperglycemia
is inadequately controlled despite lifestyle and optimal medical therapy. A 

 如果個案適合接受手術,應該建議以下第二型糖尿病患者接受代謝手術: 一、 無論目前血糖控制情形如何,只要身體質量指數大於40kg/m2(亞洲人種身體質量指數大於37.5kg/m2) 二、 如果調整生活習慣以及藥物治療之後,仍無法有效控制高血糖情形,而且身體質量指數介於35.0–39.9 kg/m2(亞洲人種身體質量指數介於32.5–37.4 kg/m2) (證據強度A) 

2. Metabolic surgery should be considered for adults with type 2 diabetes and BMI 30.0–34.9 kg/m2 (27.5–32.4 kg/m2 in Asian Americans)
if hyperglycemia is inadequately controlled despite optimal medical control by either oral or injectable medications (including insulin). B 

 以下的第二型糖尿病患者可以考慮接受代謝手術: 如果調整生活習慣以及藥物治療(包括注射胰島素)之後,仍無法有效控制高血糖情形,而且身體質量指數介於30.0–34.9 kg/m2(亞洲人種身體質量指數介於27.5–32.4 kg/m2) (證據強度B) 

3. Metabolic surgery should be performed in high-volume centers with multidisciplinary teams that understand and are experienced in the management of diabetes and gastrointestinal surgery. C 

 代謝手術應該由有豐富經驗(high-volume)的專業中心執行,這個專業中心必須包括有照顧糖尿病及腸胃道手術的多專科團隊。(證據強度C) 

4. Long-term lifestyle support and routine monitoring of micronutrient and nutritional status must be provided to patients after surgery,
according to guidelines for postoperative management of metabolic surgery by national and international professional societies. C

 在接受代謝手術之後,必須依照專業的減重手術醫學會制定相關的術後照顧規範,提供個案長期的生活型態調整,並且常規監測各種營養素狀況。 (證據強度C) 

5. People presenting for metabolic surgery should receive a comprehensive mental health assessment.B Surgery should be postponed in
patients with histories of alcohol or substance abuse, significant depression, suicidal ideation, or other mental health conditions until
these conditions have been fully addressed. E 

 預計接受代謝手術的個案應接受全面的心理健康評估。(證據強度B) 如果有以下情形,手術應推遲進行,直到這些情形已經被充分解決。一、具有酒精或者酒精史的患者;二、物質濫用;三、重度憂鬱症;四、自殺意念;五、其他心理健康狀況 (證據強度E) 

6. People who undergo metabolic surgery should be evaluated to assess the need for ongoing mental health services to help them adjust to medical and psychosocial changes after surgery. C 

經歷代謝手術的個案應持續進行心理評估,以幫助他們調適,接受手術後醫療和心理社會的改變。 

圖片來源:http://www.freepik.com/free-photo/surgeons-standing-in-operation-room_1008409.htm#term=surgery&page=2&position=20

參考資料: 
http://professional.diabetes.org/sites/professional.diabetes.org/files/media/dc_40_s1_final.pdf 

本網站資訊並無法完全取代專業醫護諮詢,如有醫療問題,請洽專業醫療團隊

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Dr. Oilcut

微創減重手術及糖尿病手術:蔡明憲教授

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