CIRURGIA METABÓLICA EM DOENTES COM DIABETES TIPO 2. FICÇÃO OU OPÇÃO TERAPÊUTICA?

  • Hans Eickhoff Centro de Obesidade, Hospital de Santiago - Luz Saúde, EN 10, km 37, 2900-722, Setúbal, Portugal Instituto de Imagem Biomédica e Ciências da Vida (IBILI), Faculdade de Medicina, Universidade de Coimbra, Polo III, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
  • Paulo Matafome Instituto de Imagem Biomédica e Ciências da Vida (IBILI), Faculdade de Medicina, Universidade de Coimbra, Polo III, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de Coimbra, Rua 5 de Outubro, São Martinho do Bispo, 3046-854 Coimbra, Portugal
  • Raquel Seiça Instituto de Imagem Biomédica e Ciências da Vida (IBILI), Faculdade de Medicina, Universidade de Coimbra, Polo III, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal Instituto de Fisiologia, Faculdade de Medicina, Universidade de Coimbra, Polo III, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
  • Francisco Castro e Sousa Serviço de Cirurgia A, Hospitais da Universidade de Coimbra, Rua Fonseca Pinto, 3000-075 Coimbra, Portugal Faculdade de Medicina, Universidade de Coimbra, Rua Larga, 3004-504 Coimbra, Portugal

Resumo

A diabetes tipo 2 tem uma elevada prevalência a nível mundial e está associada à inatividade física e ao excesso de peso. Em doentes obesos, a redução de peso através de cirurgia bariátrica tem-se revelado mais eficaz no controlo do metabolismo glicídico que abordagens conservadoras. Por outro lado, o reconhecimento do papel das hormonas digestivas no controlo glicémico e na homeostase energética conduziu a uma nova visão dos mecanismos subjacentes à cirurgia bariátrica que, no contexto da sua eficácia no controlo de comorbilidades, também tem sido apelidada de cirurgia metabólica. Após a cirurgia, observa-se um aumento pós-prandial das hormonas com efeitos anorético e incretina, bem como a supressão de hormonas orexigénicas. Estudos experimentais em modelos não-obesos de diabetes tipo 2 demonstraram efeitos pós-cirúrgicos semelhantes, aparentemente independentes da perda de peso. Pequenas séries iniciais, utilizando técnicas estandardizadas em doentes portadores de diabetes tipo 2 com um índice de massa corporal <35 kg/m2, demonstraram resultados favoráveis. Novas técnicas cirúrgicas derivadas da experimentação animal que incluem a transposição de um segmento ileal para o tubo digestivo próxima,l demonstraram resultados promissores em estudos que incluíam doentes diabéticos tipo 2 anteriormente considerados sem indicação cirúrgica. Sociedades científicas da área médica e da área cirúrgica têm vindo a modificar as suas orientações terapêuticas no sentido de considerar a opção cirúrgica num grupo cada vez mais alargado de doentes.

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Publicado
2016-03-30
Como Citar
EICKHOFF, Hans et al. CIRURGIA METABÓLICA EM DOENTES COM DIABETES TIPO 2. FICÇÃO OU OPÇÃO TERAPÊUTICA?. Revista Portuguesa de Cirurgia, [S.l.], n. 36, p. 19-28, mar. 2016. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/453>. Acesso em: 13 nov. 2019.
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