Tom 16, Nr 4 (2019)
Z pogranicza kardiologii
Opublikowany online: 2019-10-20
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Hipoglikemia u pacjentów poddanych chirurgii metabolicznej — przegląd literatury
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Choroby Serca i Naczyń 2019;16(4):270-277.
Streszczenie
Chirurgia bariatryczna jest obecnie najbardziej skuteczną metodą leczenia otyłości, niezależnie od zastosowanej metody, ponieważ w porównaniu z metodami niechirurgicznymi zapewnia większą redukcję masy ciała oraz kontrolę nad chorobami współtowarzyszącymi, przede wszystkim cukrzycą typu 2. Istotnym powikłaniem zabiegów chirurgii metabolicznej, zarówno u chorych na cukrzycę typu 2, jak i u osób bez cukrzycy, jest występowanie hipoglikemii — we wczesnej fazie pooperacyjnej najczęściej związanej z tak zwanym zespołem poposiłkowym, później (kilka miesięcy lub lat po operacji) spowodowanej endogennym hiperinsulinizmem (PBSH, hipoglikemia występująca po zabiegach bariatrycznych). Częstość występowania PBSH znacznie się waha, wynosząc 0,1–50%, zależnie od przyjętych kryteriów. Patomechanizm tego zjawiska jest wieloczynnikowy i oparty między innymi na nieadekwatnym wydzielaniu inkretyn, w tym przede wszystkim glukagonopodobnego peptyd typu 1, w odpowiedzi na posiłek, zmodyfikowany metabolizm wątrobowy glukozy czy obniżenie stężenia greliny. W związku z brakiem dokładnej wiedzy na temat patofizjologii tego zjawiska brakuje jednoznacznych algorytmów leczenia. Niemniej można wyróżnić trzy opcje terapeutyczne: modyfikację diety, farmakoterapię i leczenie chirurgiczne.
Słowa kluczowe: hipoglikemiachirurgia metabolicznabariatria
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