비만 수술 권장 할 만 한가 어떻게 수술하는 것인가 어떤 부작용이 있는가 > 복약 지도

비만 수술 권장 할 만 한가 어떻게 수술하는 것인가 어떤 부작용이 있는가

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비만 수술 권장 할 만 한가 
 
어떻게 수술하는 것인가 
 
어떤 부작용이 있는가
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미국 국립 보건원은 
 
비만도(BMI) 35 이상인 자에게는
 
 비만 수술(Bariatric Surgery)을 권장하고 있다
 
이 수술은 위와 소장의 연결 구조를 
 
개조하는 수술이지만 효과가 확실하다 
 
 
수술 후 2년 이내에 체중 50%를 줄일 수 있다
 
당뇨병과 심장병의 악화로부터 해방된다
 
특히 비만으로 인한 사망을 23-40% 감소시킨다
 
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1-2일 입원으로 퇴원한다
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북부를 절개하지 않고
 
복강경을 통해 하는 수술이 대부분이며
 
1-2일 입원만으로 퇴원한다
 
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수술 중 87%는 위 회피 술 
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위 회피 술 (Gastric bypass) 이라 함은 
 
음식이 식도를 통과한 후
 
위로 들어가지 않고 
 
소장으로 직접 들어가도록 하는 방법이다
 
이 방법은 음식을 적게 흡수되게 하는 방법이다
 
수술 방법 중 87%을 차지 한다 
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[그림 복강경으로 시술한 Gastric bypass (위 회피 술); 
음식이 위를 통과하지 않고 직접 소장으로 연결 
 
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수술 중 20%는 위를 동여매는 방법이다
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수술 중 20%는 위를 동여 매는 수술을 한다
 
이를 Gastric Banding (위 밴딩술)이라 한다
 
위의 상부를 동여매면
 
상부의 적은 부분만이 위 역할을 한다
 
아래쪽 위는 묵인 채 비여 있어 위 역할을 하지 못한다
 
음식이 상부 위에 조금 들어차도
 
식욕을 잃고 포만감을 느껴 식사를 중단하게 된다
 

 
 
<IMG style="WIDTH: 527px; HEIGHT: 523px" src="/_dimg/2%20밴딩술.bmp" width=529 height=411>
[그림] Gastric Banding 법 : 
위의 상부를 동여매어 적은 파우치 형태의 위만 남기는 기술
 
 
 
필요할 때는 묶인 곳을 임으로 열리게 하여 위 구실을 하게 한다
 

 
 
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[그림] 필요할 때는 묶인 곳을 임의로 열리게 하여 위 구실을 하게 한다
 
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보통 수술 하는 경우 와 같은 
 
부작용만 잇을수 있다 
 
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수술로 인한 부작용은
 
 보통 수술법 정도의 부작용들이다
 
수술 후 30일간 나타난 부작용을 비교하면 다음과 같다
 
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Gastric banding</TD>
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Gastric bypass</TD></TR>
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(위 동며매는 법)</TD>
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식도에서 소장으로 직접 연결법</TD></TR>
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복강경 시술</TD>
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복부 절개술</TD></TR>
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시술 확률 </TD>
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20%</TD>
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87%</TD>
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3%</TD></TR>
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사망</TD>
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0</TD>
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0.2%</TD>
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2.1%</TD></TR>
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중증 부작용
(정맥혈전증 등)</TD>
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4.3%</TD>
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1%</TD>
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7.8%</TD></TR>
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가장 많은 부작용</TD>
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더부룩함, 설사 등 --------20%</TD></TR></TBODY></TABLE>
 
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체중 감소는 서서히 그러나 확실하다
 
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수술하자마자 체중 감소는 서서히 시작하나 확실하다
수술 후 30개월간 나타난 체중 감소 효과는 아래와 같다
 
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체중 감소 량</TD></TR>
<TR style="HEIGHT: 24pt; mso-yfti-irow: 1">
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복강경 시술</TD>
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복부 절개 법</TD></TR>
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Bypass 법</TD>
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38kg</TD>
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42kg</TD></TR>
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Banding 법</TD>
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35kg</TD>
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 </TD></TR>
<TR style="mso-yfti-irow: 2; mso-yfti-lastrow: yes">
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근거</TD>
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<A href="http://content.nejm.org/content/vol361/issue5/index.dtl">July 30,2009</A> NEJM: No 5 ;Volume 361:445-454; Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery 
 
The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium :  Columbia University; University of Washington,
Neuropsychiatric Research Institute; East Carolina University; 
University of Pittsburgh Medical Center; Oregon Health and Science University</TD></TR></TBODY></TABLE>