P\u00ebrkufizimi dhe klasifikimi i obezitetit:<\/p>\n\n\n\n
Organizata Bot\u00ebrore e Sh\u00ebndet\u00ebsis\u00eb (OBSH) e p\u00ebrkufizon obezitetin si nj\u00eb gjendje t\u00eb akumulimit t\u00eb tep\u00ebrt t\u00eb yndyr\u00ebs n\u00eb trup n\u00eb mas\u00ebn q\u00eb ndikon negativisht n\u00eb sh\u00ebndetin dhe mir\u00ebqenien.1 N\u00ebse sasia e yndyr\u00ebs trupore tejkalon vlerat normale fiziologjike, nj\u00eb person \u00ebsht\u00eb i trash\u00eb. Fiziologjikisht, sasia normale e yndyr\u00ebs s\u00eb trupit ndryshon shum\u00eb midis individ\u00ebve n\u00eb var\u00ebsi t\u00eb mosh\u00ebs dhe gjinis\u00eb.<\/p>\n\n\n\n
BMI (Body Mass Index, BMI), i cili p\u00ebrcaktohet duke pjes\u00ebtuar pesh\u00ebn me lart\u00ebsin\u00eb n\u00eb metra, p\u00ebrdoret m\u00eb s\u00eb shpeshti p\u00ebr t\u00eb klasifikuar shkall\u00ebn e obezitetit.2,3 N\u00eb p\u00ebrgjith\u00ebsi, diapazoni i BMI-s\u00eb s\u00eb sh\u00ebndetshme \u00ebsht\u00eb nga 18,5 deri n\u00eb 24,9 kg\/m2. Mbipesha p\u00ebrcaktohet si nj\u00eb BMI prej 25 deri n\u00eb 29,9 kg\/m2. Kur BMI e llogaritur i kalon 30 kg\/m2, p\u00ebrkufizohet si obezitet. Obeziteti mund t\u00eb ndahet sipas n\u00ebnklasave t\u00eb BMI. Prandaj, BMI: 30-34,9 obeziteti i klas\u00ebs 1; BMI: 35-39,9 obeziteti i klas\u00ebs 2; BMI: 40 e lart quhet obeziteti ekstrem i klas\u00ebs 3. N\u00ebse BMI \u00ebsht\u00eb 50 e lart, p\u00ebrdoret termi superobezitet. S\u00ebmundjet q\u00eb lidhen me obezitetin zakonisht ndodhin kur BMI rritet n\u00eb 30 e lart. P\u00ebr k\u00ebt\u00eb arsye, kur obeziteti shfaqet s\u00eb bashku me s\u00ebmundje t\u00eb tilla si diabeti, hipertensioni, s\u00ebmundjet e arterieve koronare, apnea e gjumit, deformimet e ky\u00e7eve, depresioni dhe s\u00ebmundjet e refluksit t\u00eb lidhura me obezitetin, ne p\u00ebrdorim termin obezitet morbid.<\/p>\n\n\n\n
Nj\u00eb tjet\u00ebr paramet\u00ebr i r\u00ebnd\u00ebsish\u00ebm \u00ebsht\u00eb perimetri i belit, i cili mund t\u00eb p\u00ebrdoret s\u00eb bashku me nj\u00eb vler\u00eb BMI p\u00ebr t\u00eb vler\u00ebsuar rrezikun p\u00ebr sh\u00ebndetin e individ\u00ebve. Raporti bel\/ij\u00eb lidhet me shp\u00ebrndarjen e yndyr\u00ebs n\u00eb trup. Pacient\u00ebt me nj\u00eb raport bel\/ije m\u00eb t\u00eb vog\u00ebl se 1 priren t\u00eb ken\u00eb nj\u00eb raport periferik t\u00eb shp\u00ebrndarjes s\u00eb yndyr\u00ebs, shpesh i referuar si shp\u00ebrndarje “dardh\u00eb”. Kjo shp\u00ebrndarje yndyre ka nj\u00eb rrezik t\u00eb ul\u00ebt p\u00ebr sh\u00ebndetin. Pacient\u00ebt me nj\u00eb raport bel\/ije m\u00eb shum\u00eb se 1 quhen “moll\u00eb” ose shp\u00ebrndarja qendrore e yndyr\u00ebs dhe k\u00ebta pacient\u00eb konsiderohen t\u00eb ken\u00eb nj\u00eb rrezik t\u00eb lart\u00eb p\u00ebr sh\u00ebndetin.<\/p>\n\n\n\n
Tek f\u00ebmij\u00ebt (mosha 2-19), mbipesha p\u00ebrkufizohet si obezitet n\u00ebse BMI p\u00ebr mosh\u00ebn \u00ebsht\u00eb e barabart\u00eb ose m\u00eb e madhe se p\u00ebrqindja e 95-t\u00eb n\u00eb grafik\u00ebt e rritjes s\u00eb Qendrave p\u00ebr Kontrollin dhe Parandalimin e S\u00ebmundjeve (CDC) dhe mbipesh\u00eb n\u00ebse \u00ebsht\u00eb midis 85- 9.4<\/p>\n\n\n\n
33.0% e popullsis\u00eb s\u00eb rritur t\u00eb bot\u00ebs (1.4 miliard\u00eb njer\u00ebz) \u00ebsht\u00eb mbipesh\u00eb ose obez\u00eb, nj\u00eb problem i r\u00ebnd\u00ebsish\u00ebm dhe n\u00eb rritje i sh\u00ebndetit publik si n\u00eb rajonet e zhvilluara ekonomikisht ashtu edhe n\u00eb rajonet n\u00eb zhvillim t\u00eb bot\u00ebs. M\u00eb shum\u00eb se 1.4 miliard\u00eb t\u00eb rritur ishin mbipesh\u00eb n\u00eb vitin 2008 dhe m\u00eb shum\u00eb se 40 milion\u00eb f\u00ebmij\u00eb n\u00ebn pes\u00eb vje\u00e7 n\u00eb 2010. N\u00ebse tendencat e fundit vazhdojn\u00eb, vler\u00ebsohet se shkalla e mbipesh\u00ebs ose e trash\u00eb e popullsis\u00eb s\u00eb rritur t\u00eb bot\u00ebs do t\u00eb rritet n\u00eb 57.8% t\u00eb popullsis\u00eb totale (3.3 miliard\u00eb njer\u00ebz) deri n\u00eb vitin 2030.5<\/p>\n\n\n\n
Ekziston nj\u00eb nevoj\u00eb e qart\u00eb p\u00ebr rritjen e nd\u00ebrgjegj\u00ebsimit dhe edukimit t\u00eb publikut rreth etiologjis\u00eb komplekse t\u00eb obezitetit dhe barrierave t\u00eb r\u00ebnd\u00ebsishme q\u00eb ekzistojn\u00eb n\u00eb p\u00ebrpjekjet p\u00ebr t\u00eb arritur humbje t\u00eb q\u00ebndrueshme n\u00eb pesh\u00eb. Obeziteti \u00ebsht\u00eb nj\u00eb s\u00ebmundje kronike me nj\u00eb etiologji komplekse dhe nj\u00eb gjendje e p\u00ebrjetshme p\u00ebr shumic\u00ebn e njer\u00ebzve t\u00eb trash\u00eb. Prandaj, plaga e shkaktuar nga etiketimi i trash\u00eb q\u00eb n\u00eb mosh\u00eb t\u00eb re zgjat gjith\u00eb jet\u00ebn. Mb\u00ebshtetja e individ\u00ebve, pavar\u00ebsisht nga mosha e pacientit, me m\u00ebnyra psikologjike adaptive p\u00ebr t\u00eb p\u00ebrballuar stigm\u00ebn e pesh\u00ebs mund t\u00eb leht\u00ebsoj\u00eb rezultatet e humbjes s\u00eb pesh\u00ebs.<\/p>\n\n\n\n
Pas k\u00ebsaj hyrjeje, \u00ebsht\u00eb e nevojshme t\u00eb t\u00ebrhiqet v\u00ebmendja n\u00eb nj\u00eb pik\u00eb. Shkalla e vdekjeve nga kushtet e lidhura me obezitetin rritet me mosh\u00ebn; Vdekshm\u00ebria duksh\u00ebm m\u00eb e lart\u00eb nga t\u00eb gjitha shkaqet \u00ebsht\u00eb v\u00ebrejtur te individ\u00ebt obez\u00eb krahasuar me subjektet me pesh\u00eb normale dhe nj\u00eb studim vuri n\u00eb dukje se vdekshm\u00ebria kishte t\u00eb ngjar\u00eb t\u00eb ndodhte 9,44 vjet m\u00eb par\u00eb tek ata q\u00eb ishin obez\u00eb (BMI, \u226530).6 Efektet e d\u00ebmshme t\u00eb obezitetit n\u00eb sistemi kardiovaskular dhe kushtet sh\u00ebndet\u00ebsore si kanceri P\u00ebr shkak t\u00eb problemeve t\u00eb tij, efektet e kirurgjis\u00eb bariatrike n\u00eb mbijetes\u00ebn e p\u00ebrgjithshme jan\u00eb v\u00ebrtetuar n\u00eb shum\u00eb studime. P\u00ebr shembull, n\u00eb studimin SOS suedez, u raportua se kishte nj\u00eb p\u00ebrmir\u00ebsim prej 30.7% t\u00eb vdekshm\u00ebris\u00eb n\u00eb 10 vjet iu n\u00ebnshtrua nj\u00eb operacioni bariatrik ul vdekshm\u00ebrin\u00eb me 41% n\u00eb krahasim me popullat\u00ebn obeze q\u00eb nuk i ishte n\u00ebnshtruar operacionit.8 Prandaj, shkaktoi probleme serioze sh\u00ebndet\u00ebsore dhe rritje t\u00eb vdekshm\u00ebris\u00eb Trajtimi i obezitetit, i cili p\u00ebrshpejton obezitetin<\/p>\n\n\n\n
Pse b\u00ebhemi obez\u00eb? Si t\u00eb zhvillojm\u00eb ndjenj\u00ebn e uris\u00eb dhe ndjenj\u00ebn e ngopjes?<\/p>\n\n\n\n
Ekzistojn\u00eb rrug\u00eb komunikimi nervore dhe hormonale midis trurit dhe sistemit t\u00eb tretjes.
Kur jemi t\u00eb uritur, hormoni Ghrelin i l\u00ebshuar nga stomaku bosh d\u00ebrgon nj\u00eb sinjal n\u00eb tru – ju jeni t\u00eb uritur, hani – nd\u00ebrsa hormoni Leptin i l\u00ebshuar nga stomaku i ngopur kur jemi t\u00eb ngopur d\u00ebrgon nj\u00eb sinjal – jeni t\u00eb ngopur, ndaloni s\u00eb ngr\u00ebni tani. . Kjo vazhdon n\u00eb nj\u00eb gjendje ekuilibri.<\/p>\n\n\n\n
Rajoni n\u00eb trurin ton\u00eb i quajtur hipotalamus siguron ekuilibrin midis marrjes s\u00eb l\u00ebnd\u00ebve ushqyese dhe konsumit t\u00eb energjis\u00eb q\u00eb rezulton. N\u00ebn menaxhimin e k\u00ebsaj qendre lind nevoja p\u00ebr energji, uj\u00eb dhe l\u00ebnd\u00eb t\u00eb tjera ushqyese, si dhe ndjenja e uris\u00eb, ngopjes dhe etjes. L\u00ebnd\u00ebt ushqyese t\u00eb marra n\u00eb trup, nga m\u00eb t\u00eb lartat tek ato m\u00eb t\u00eb ul\u00ebtat sipas p\u00ebrmbajtjes s\u00eb tyre kalorike, jan\u00eb yndyrat, karbohidratet, proteinat, vitaminat dhe mineralet. Pasi k\u00ebto substanca jan\u00eb g\u00eblltitur, ato metabolizohen dhe k\u00ebshtu jeta vazhdon. Marrja e ushqimit t\u00eb nj\u00eb individi t\u00eb rriturP\u00ebraf\u00ebrsisht 1500-1600 kcal n\u00eb dit\u00eb nga energjia e marr\u00eb si rezultat i metabolizmit shpenzohet p\u00ebr metabolizmin bazal. Truri yn\u00eb, indet nervore, qelizat e kuqe t\u00eb gjakut, qelizat e bardha t\u00eb gjakut dhe qelizat e veshkave p\u00ebrdorin vet\u00ebm glukoz\u00eb. P\u00ebr k\u00ebt\u00eb arsye, ekziston nj\u00eb nevoj\u00eb e vazhdueshme p\u00ebr sheqer dhe sheqeri n\u00eb gjak duhet t\u00eb mbahet i balancuar. P\u00ebraf\u00ebrsisht 50% e pjes\u00ebs s\u00eb karbohidrateve q\u00eb shnd\u00ebrrohet n\u00eb glukoz\u00eb pasi merret n\u00eb trup dhe tretet, shnd\u00ebrrohet n\u00eb energji nga glikoliza, 30-40% shnd\u00ebrrohet n\u00eb yndyrna p\u00ebr ruajtje dhe 10% shnd\u00ebrrohet n\u00eb glikogjen p\u00ebr t’u ruajtur si nj\u00eb rezerv\u00eb n\u00eb m\u00ebl\u00e7i dhe indet e muskujve. Gjenetikisht, \u00ebsht\u00eb nj\u00eb mekaniz\u00ebm mbrojt\u00ebs i trupit kund\u00ebr uris\u00eb. Megjithat\u00eb, nuk ka asnj\u00eb mekaniz\u00ebm n\u00eb trup p\u00ebr t\u00eb ndaluar ngr\u00ebnien e tep\u00ebrt. I gjith\u00eb mekanizmi funksionon n\u00eb nj\u00eb drejtim dhe sado energji t\u00eb hyj\u00eb, e ruan energjin\u00eb e tep\u00ebrt duke e kthyer n\u00eb glikogjen dhe kryesisht yndyr\u00eb. Nuk ka asnj\u00eb mekaniz\u00ebm n\u00eb trupin e njeriut q\u00eb thot\u00eb se kam grumbulluar shum\u00eb yndyr\u00eb dhe nuk duhet ta ruaj m\u00eb. P\u00ebr m\u00eb tep\u00ebr, n\u00eb agj\u00ebrimin e zgjatur, fillimisht konsumohen rezervat e glikogjenit n\u00eb m\u00ebl\u00e7i dhe muskuj dhe m\u00eb pas fillojn\u00eb t\u00eb p\u00ebrdoren yndyrnat e ruajtura. P\u00ebr k\u00ebt\u00eb arsye, akumulimin e k\u00ebsaj yndyre t\u00eb tep\u00ebrt, ve\u00e7an\u00ebrisht n\u00eb organet e brendshme, bark, gjoks, ijet dhe pjes\u00ebt e sip\u00ebrme t\u00eb k\u00ebmb\u00ebs e quajm\u00eb obezitet.<\/p>\n\n\n\n
Trajtimi i obezitetit: N\u00eb trajtimin e obezitetit, p\u00ebrkat\u00ebsisht;<\/p>\n\n\n\n
Dieta: Trajtimi i zvog\u00eblimit t\u00eb l\u00ebnd\u00ebve ushqyese q\u00eb hyjn\u00eb n\u00eb trup p\u00ebrmes diet\u00ebs: 98% rezulton me d\u00ebshtim, pra humbje peshe dhe s\u00ebrish shtim n\u00eb pesh\u00eb.<\/p>\n\n\n\n
Ushtrimi: Ai synon t\u00eb heq\u00eb qafe yndyr\u00ebn e depozituar duke rritur shpenzimin e energjis\u00eb p\u00ebrmes st\u00ebrvitjes.<\/p>\n\n\n\n
Trajtimi i ndryshimit t\u00eb sjelljes: N\u00eb nj\u00eb studim ku individ\u00ebt u pyet\u00ebn n\u00eb lidhje me sjelljet e gabuara t\u00eb t\u00eb ngr\u00ebnit q\u00eb shkaktojn\u00eb shtim n\u00eb pesh\u00eb, 80% than\u00eb “t\u00eb hahet shpejt dhe shum\u00eb”, 64% than\u00eb “ngr\u00ebnia e shum\u00eb ushqimeve me yndyr\u00eb dhe karbohidrate”, 56% than\u00eb se han\u00eb kur jan\u00eb t\u00eb shqet\u00ebsuar. (ngr\u00ebnia emocionale\u201d, nd\u00ebrsa 44% jan\u00eb p\u00ebrgjigjur \u201ct\u00eb hahet pa u ndjer\u00eb i uritur, t\u00eb mos ndihet i ngopur (sulme t\u00eb tepruara)\u201d. Sulmet e t\u00eb ngr\u00ebnit, ngr\u00ebnia gjat\u00eb nat\u00ebs dhe m\u00ebnyra e jetes\u00ebs sedentare jan\u00eb disa nga sjelljet e gabuara q\u00eb shkaktojn\u00eb obezitet. P\u00ebr shum\u00eb individ\u00eb obez\u00eb, dietat e kufizuara me energji dhe aktiviteti fizik mund t\u00eb mos jen\u00eb t\u00eb mjaftueshme p\u00ebr t\u00eb arritur dhe ve\u00e7an\u00ebrisht p\u00ebr t\u00eb ruajtur pesh\u00ebn e d\u00ebshiruar trupore. P\u00ebr shkak t\u00eb obezitetit; \u00cbsht\u00eb nj\u00eb gjendje kronike q\u00eb ka potencial t\u00eb rishfaqet dhe ka nevoj\u00eb p\u00ebr trajtim afatgjat\u00eb. Terapia e modifikimit t\u00eb sjelljes, s\u00eb bashku me diet\u00ebn dhe st\u00ebrvitjen, jan\u00eb absolutisht thelb\u00ebsore p\u00ebr rezultate afatgjata dhe t\u00eb suksesshme. P\u00ebr shembull, t\u00eb b\u00ebni pazar kur jeni t\u00eb ngopur, t\u00eb mos mbani ushqimin n\u00eb sy, t\u00eb mos kaloni koh\u00eb n\u00eb kuzhin\u00eb, t\u00eb mos anashkaloni vaktet, t\u00eb mos hani rosti\u00e7eri nd\u00ebrsa shikoni TV, t\u00eb b\u00ebni miq me njer\u00ebz aktiv\u00eb, t\u00eb mos keni frik\u00eb t\u00eb lini ushqimin n\u00eb pjat\u00eb, t\u00eb hani pjes\u00ebn tjet\u00ebr. si meze, duke p\u00ebrtypur kafshat\u00ebn p\u00ebr nj\u00eb koh\u00eb t\u00eb gjat\u00eb, duke e l\u00ebn\u00eb pirunin dhe lug\u00ebn n\u00eb tavolin\u00eb gjat\u00eb p\u00ebrtypjes etj.9<\/p>\n\n\n\n
Mjekimi: \u00cbsht\u00eb thelb\u00ebsore q\u00eb medikamente t\u00eb tilla t\u00eb p\u00ebrdoren n\u00ebn mbik\u00ebqyrjen e nj\u00eb mjeku. N\u00eb m\u00ebnyr\u00eb q\u00eb trajtimi i obezitetit t\u00eb jet\u00eb i suksessh\u00ebm, pacienti duhet t\u00eb pranoj\u00eb t\u00eb vazhdoj\u00eb diet\u00ebn dhe ushtrimet fizike si dhe mjekimin, dhe m\u00eb pas t\u00eb vij\u00eb p\u00ebr kontrolle n\u00eb intervale t\u00eb rregullta.<\/p>\n\n\n\n
Trajtimet endoskopike: Ky grup p\u00ebrfshin teknika dhe teknika q\u00eb konsumojn\u00eb hap\u00ebsir\u00eb \u200b\u200bdhe\/ose kufizojn\u00eb v\u00ebllimin dhe teknikat q\u00eb d\u00ebmtojn\u00eb p\u00ebrthithjen. Shembuj t\u00eb teknikave q\u00eb konsumojn\u00eb hap\u00ebsir\u00eb \u200b\u200bjan\u00eb baloni intragastrik10 dhe shuttle transpyloric11. Risip\u00ebrfaqja e mukoz\u00ebs duodenale11 mund t\u00eb jepet si shembull i nj\u00eb metode endoskopike q\u00eb redukton p\u00ebrthithjen. Baloni gastrik \u00ebsht\u00eb nj\u00eb metod\u00eb e fryrjes s\u00eb nj\u00eb tullumbace silikoni t\u00eb d\u00ebrguar n\u00eb stomak me metod\u00eb endoskopike me krip\u00eb fiziologjike q\u00eb p\u00ebrmban blu metilen. K\u00ebshtu, krijon v\u00ebllim n\u00eb stomak dhe jep nj\u00eb ndjenj\u00eb t\u00eb ngopjes dhe ngopjes s\u00eb hershme. K\u00ebto balona, \u200b\u200bt\u00eb cilat p\u00ebrdoren p\u00ebr t\u00eb reduktuar madh\u00ebsin\u00eb e m\u00ebl\u00e7is\u00eb s\u00eb dhjamosur t\u00eb njer\u00ebzve jasht\u00ebzakonisht obez\u00eb gjat\u00eb periudh\u00ebs s\u00eb p\u00ebrgatitjes p\u00ebr kirurgji dhe p\u00ebr t\u00eb zvog\u00ebluar v\u00ebshtir\u00ebsin\u00eb e operacionit, sot p\u00ebrdoren p\u00ebr t\u00eb ndihmuar mbipesh\u00ebn (BMI: 25-29,9) dhe obez\u00ebt e klas\u00ebs 1. njer\u00ebzit (BMI: 30-34.9) pa s\u00ebmundje t\u00eb pakontrolluara t\u00eb humbjes s\u00eb pesh\u00ebs p\u00ebrdoret gjithashtu p\u00ebr (Figura 1)<\/p>\n\n\n\n
Trajtimi kirurgjik: Metoda m\u00eb e suksesshme n\u00eb trajtimin e obezitetit \u00ebsht\u00eb kirurgjia. N\u00eb k\u00ebt\u00eb drejtim, qasja kirurgjikale ndahet kryesisht n\u00eb dy. Q\u00ebllimi i kirurgjis\u00eb bariatrike p\u00ebr t\u00eb reduktuar marrjen e energjis\u00eb nga ushqimi \u00ebsht\u00eb ose t\u00eb reduktoj\u00eb v\u00ebllimin e marrjes s\u00eb l\u00ebnd\u00ebve ushqyese n\u00eb traktin gastrointestinal ose t\u00eb zvog\u00ebloj\u00eb p\u00ebrthithjen e k\u00ebtyre l\u00ebnd\u00ebve ushqyese. P\u00ebr k\u00ebt\u00eb q\u00ebllim, jan\u00eb p\u00ebrdorur historikisht metoda t\u00eb tilla si gastroplastika me m\u00ebng\u00eb vertikale (e braktisur), aplikimi i brezit gastrik t\u00eb rregulluesh\u00ebm12 (sot preferohet rrall\u00eb), gastrektomia me m\u00ebng\u00eb13, bypass gastrike Roux-en-Y14, mini bypass gastrike15. Si rezultat i k\u00ebtyre operacioneve, jo vet\u00ebm q\u00eb energjia q\u00eb hyn n\u00eb sistem zvog\u00eblohet, por stimulohet sekretimi i insulin\u00ebs s\u00eb varur nga glukoza, zbrazja e stomakut vonohet dhe oreksi shtypet me ndihm\u00ebn e inkretinave q\u00eb \u00e7lirohen nga sistemi tret\u00ebs. Ky kombinim i efekteve jep nj\u00eb kontribut t\u00eb r\u00ebnd\u00ebsish\u00ebm n\u00eb homeostaz\u00ebn e glukoz\u00ebs, ve\u00e7an\u00ebrisht n\u00eb kontrollin e glukoz\u00ebs pas ngr\u00ebnies. N\u00eb k\u00ebt\u00eb m\u00ebnyr\u00eb, ata gjithashtu mb\u00ebshtesin humbjen e pesh\u00ebs.<\/p>\n\n\n\n
Teknikat kirurgjikale m\u00eb t\u00eb preferuara sot n\u00eb kirurgjin\u00eb e obezitetit jan\u00eb:<\/p>\n\n\n\n
Kirurgjia e obezitetit ka nj\u00eb efekt n\u00eb humbjen e pesh\u00ebs n\u00eb 3 m\u00ebnyra:<\/p>\n\n\n\n
1-Teknikat kufizuese, kufizuese t\u00eb v\u00ebllimit:<\/p>\n\n\n\n
a) Shirit gastrik t\u00eb rregulluesh\u00ebm laparoskopik (LAGB): Shirit gastrik t\u00eb rregulluesh\u00ebm laparoskopik (LapoRrjedha e rregullueshme gastrike roskopike (LAGB) u b\u00eb e njohur n\u00eb nj\u00eb koh\u00eb t\u00eb shkurt\u00ebr p\u00ebr shkak t\u00eb leht\u00ebsis\u00eb s\u00eb teknik\u00ebs dhe munges\u00ebs s\u00eb ndonj\u00eb ndryshimi anatomik kur u p\u00ebrdor p\u00ebr her\u00eb t\u00eb par\u00eb. K\u00ebto shirita silikoni vendosen n\u00eb stomak p\u00ebrmes nj\u00eb tuneli t\u00eb krijuar n\u00eb kryq\u00ebzimin ezofagogastrik16. Nj\u00eb port\u00eb e ngjashme me portat e kimioterapis\u00eb vendoset n\u00ebn l\u00ebkur\u00eb p\u00ebr t\u00eb qen\u00eb e rregullueshme. Prej k\u00ebtu futet nj\u00eb gjilp\u00ebr\u00eb e posa\u00e7me dhe rregullohet diametri i lumenit me krip\u00eb fiziologjike. P\u00ebr shembull, n\u00ebse ai ka humbur shum\u00eb pesh\u00eb, ajo shuhet. N\u00ebse humbja e pesh\u00ebs \u00ebsht\u00eb e pamjaftueshme, ajo \u00ebsht\u00eb e fryr\u00eb. Megjithat\u00eb, me kalimin e koh\u00ebs, jan\u00eb shfaqur shum\u00eb komplikime t\u00eb tilla si rr\u00ebshqitja e k\u00ebtyre balonave, migrimi n\u00eb stomak duke shpuar murin e stomakut dhe infeksionet n\u00eb vendin e portit, dhe sot ato p\u00ebrdoren rrall\u00eb n\u00eb raste shum\u00eb t\u00eb p\u00ebrzgjedhura17 (Figura 2)<\/p>\n\n\n\n
Figura 2: Llojet e brezit gastric t\u00eb rregulluesh\u00ebm laparoskopik (LAGB) dhe tipet e brezit gastric t\u00eb parregulluesh\u00ebm MiniMizer.<\/p>\n\n\n\n
b) Gastrektomia e m\u00ebng\u00ebs (gastrektomia me m\u00ebng\u00eb) \u00ebsht\u00eb teknika e heqjes kirurgjikale laparoskopike t\u00eb af\u00ebrsisht 75-80% t\u00eb stomakut n\u00eb rrafshin vertikal (Figura 3) ishte n\u00eb fakt faza e par\u00eb e teknik\u00ebs s\u00eb diversionit biliopankreatik \u00ebsht\u00eb nj\u00eb operacion m\u00eb kompleks. Megjithat\u00eb, nd\u00ebrsa prisnin p\u00ebr operacionin e faz\u00ebs s\u00eb dyt\u00eb, pacient\u00ebt p\u00ebsuan p\u00ebrmir\u00ebsim n\u00eb s\u00ebmundjet serioze shoq\u00ebruese dhe humbje adekuate n\u00eb pesh\u00eb. M\u00eb pas, ajo filloi t\u00eb kryhet si nj\u00eb teknik\u00eb e pavarur e kirurgjis\u00eb s\u00eb obezitetit n\u00eb gjysm\u00ebn e par\u00eb t\u00eb viteve 2000. Sekuenca normale anatomike nuk ndryshon n\u00eb gastrektomin\u00eb e m\u00ebng\u00ebs. Nuk ka p\u00ebrkeq\u00ebsim serioz n\u00eb p\u00ebrthithjen e ushqimeve, vitaminave dhe element\u00ebve gjurm\u00eb. P\u00ebr k\u00ebt\u00eb arsye, ajo \u00ebsht\u00eb b\u00ebr\u00eb teknika kirurgjikale m\u00eb e aplikuar sot18-25<\/p>\n\n\n\n
Figura 3: Gastrektomia laparoskopike me m\u00ebng\u00eb. Ky operacion kryhet n\u00eb m\u00ebnyr\u00eb laparoskopike me pajisje speciale t\u00eb quajtur endostapler. (Numri i stokut t\u00eb shutterstock: 1135976798)<\/p>\n\n\n\n
a) Bypass-i i dhimbjeve t\u00eb barkut Jejuno (i braktisur),<\/p>\n\n\n\n
b) Bypass ileal jejuno nga skaji n\u00eb an\u00eb<\/p>\n\n\n\n
a) Bypass gastrik Roux-en-Y: \u00cbsht\u00eb edhe nj\u00eb teknik\u00eb kufizuese e v\u00ebllimit dhe keqp\u00ebrthithjes p\u00ebr humbje peshe. \u00cbsht\u00eb p\u00ebrdorur p\u00ebr trajtimin e obezitetit q\u00eb nga vitet 197026. N\u00eb k\u00ebt\u00eb operacion, nj\u00eb qese e vog\u00ebl gastrike krijohet n\u00eb pjes\u00ebn proksimale t\u00eb stomakut. M\u00eb pas, zorr\u00ebt e holla lidhen me stomakun n\u00eb form\u00eb Y (Figura 4). Duke qen\u00eb se \u00ebsht\u00eb nj\u00eb teknik\u00eb e kufizimit t\u00eb v\u00ebllimit dhe e keqp\u00ebrthithjes, preferohet t\u00eb b\u00ebhet gastrektomia me m\u00ebng\u00eb te individ\u00ebt obez\u00eb me diabet t\u00eb tipit 2.27 Meqen\u00ebse d\u00ebmton p\u00ebrthithjen, statusin ushqyes gjat\u00eb gjith\u00eb jet\u00ebs, nivelet e proteinave dhe vitaminave dhe element\u00ebt gjurm\u00eb duhet t\u00eb kontrollohen dhe z\u00ebvend\u00ebsohen kur e nevojshme.<\/p>\n\n\n\n
b) Mini bypass gastrik=MGB=(bypass gastrik t\u00eb vet\u00ebm anastomoz\u00eb=SAGB, nj\u00eb anastomoz\u00eb gastrike bypass=OAGB) Bajpasi minigastrik u zhvillua si nj\u00eb alternativ\u00eb ndaj operacionit t\u00eb anashkalimit gastrik Roux-en-Y28. N\u00eb k\u00ebt\u00eb teknik\u00eb kirurgjikale krijohet nj\u00eb qese proksimale gastrike. Zorra e holl\u00eb m\u00eb pas lidhet me k\u00ebt\u00eb qese me nj\u00eb anastomoz\u00eb t\u00eb vetme (Figura 5). Meqen\u00ebse prish p\u00ebrthithjen, ndjekja e tij \u00ebsht\u00eb e nj\u00ebjt\u00eb me bypass-in Roux-en-Y.<\/p>\n\n\n\n
c) Dyndarja tranzit: (lloji Roux-en-Y = TB ose TB me lak (ileostomia me m\u00ebng\u00eb t\u00eb vetme anastomoze = SASI). Operacionet me dy ndarje tranzite u zhvilluan p\u00ebr t\u00eb korrigjuar diabetin e tipit 2, i cili shfaqet si nj\u00eb efekt an\u00ebsor i obezitetit tek njer\u00ebzit q\u00eb jan\u00eb obez\u00eb (BMI nd\u00ebrmjet 33-72 \u00cbsht\u00eb nj\u00eb operacion.29 Gastrektomia e m\u00ebng\u00ebs kryhet si nj\u00eb kufizues v\u00ebllimi dhe raportohet se stomaku dhe zorra e holl\u00eb hapen si nj\u00eb malabsorbues, duke shkaktuar lirimin e inkretinave nga ileumi). jan\u00eb efikase n\u00eb kap\u00ebrcimin e rezistenc\u00ebs ndaj insulin\u00ebs.29 \u00cbsht\u00eb nj\u00eb metod\u00eb efektive edhe n\u00eb trajtimin e diabetit t\u00eb tipit 2 Operacionet interpozicioni-transpozimi ileal kryhen te personat mbipesh\u00eb.30<\/p>\n\n\n\n
Vitet e fundit, studimet mbi jejunostomin\u00eb me m\u00ebng\u00eb t\u00eb vetme anastomoze (SAS-J)31 si kufizim v\u00ebllimi + keqp\u00ebrthithje kan\u00eb qen\u00eb n\u00eb vazhdim.<\/p>\n","protected":false},"excerpt":{"rendered":"
P\u00ebrkufizimi dhe klasifikimi i obezitetit: Organizata Bot\u00ebrore e Sh\u00ebndet\u00ebsis\u00eb (OBSH) e p\u00ebrkufizon obezitetin si nj\u00eb gjendje t\u00eb akumulimit t\u00eb tep\u00ebrt t\u00eb yndyr\u00ebs n\u00eb trup n\u00eb mas\u00ebn q\u00eb ndikon negativisht n\u00eb sh\u00ebndetin dhe mir\u00ebqenien.1 N\u00ebse sasia e yndyr\u00ebs trupore tejkalon vlerat normale fiziologjike, nj\u00eb person \u00ebsht\u00eb i trash\u00eb. Fiziologjikisht, sasia normale e yndyr\u00ebs s\u00eb trupit ndryshon shum\u00eb […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[117],"tags":[],"class_list":["post-29152","post","type-post","status-publish","format-standard","hentry","category-uncategorized-sq"],"_links":{"self":[{"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/posts\/29152","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/comments?post=29152"}],"version-history":[{"count":0,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/posts\/29152\/revisions"}],"wp:attachment":[{"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/media?parent=29152"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/categories?post=29152"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drburakkavlakoglu.com\/sq\/wp-json\/wp\/v2\/tags?post=29152"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}