PREOPERATIVE REVELATION OF INSULIN RESISTANCE AS A CRITERION OF DEBULKING NECESSITY IN PATIENTS WITH OBESITY
Abstract
The article considers the questions of a necessity of widening the list of obligatory preoperative examinations of patients with obesity for the choice of adequate operation volume, especially for simultaneous debulking of a greater omentum. The aim of research is an estimation of possibility of using an insulin resistance index (НОМА – IR) as a necessity criterion of simultaneous debulking of a greater omentum at operative interventions in patients with obesity.
There were examined 60 persons from the surgical stationary, divided in 2 groups. 1 group included 20 patients with the normal body mass, 2 – 40 patients with different degrees of obesity. Insulin resistance was revealed on the base of glucose and insulin estimation, HOMA-IR index calculation.
It was revealed, that glucose level in all patients doesn’t reliably exceeds the upper threshold of norm, insulin rates don’t differ from the control ones, even in patients with obesity, and rise in 20 % of patients only at 3 degree of obesity. It creates an illusion about the normal state of carbohydrate metabolism in these patients, whereas insulin resistance index estimation allows to reveal a pre-clinic stage of these disorders and to make a timely decision as to a possibility and necessity of simultaneous palliative operation as an ometnectomy that doesn’t complicate a course of operation and postoperational period, but allows to decrease an expressiveness of carbohydrate metabolism disorders at obesity.
The standard preoperative estimation of glucose level in blood doesn’t allow to diagnose an insulin resistance state, that is patients of the high risk group of metabolic syndrome development (especially the ones with obesity) need the additional insulin estimation and insulin resistance index calculation in preoperational period.Downloads
References
Dronova, V. L., Dronov, A. Y., Kryuchyna, E. A., Teslyuk, R. S., Lucenko, E. V., Nastashenko, M. Y. (2013). Simul'tannye operacii pri sochetannyh hirurgicheskih i ginekologicheskih zabolevaniyah. Ukrainskyi zhurnal hyrurgii, 2 (21). Available at: http://dronov.com.ua/viewDetail/8/7
Zaporozhan, V. N., Tatarchuk, T. F., Dronov, A. Y., Dronova, V. L., Kryuchyna, E. A. (2013). Simul'tannye operacii pri sochetanii ginekologicheskoy i hirurgicheskoy patologii. Reproduktivnaya endokrinologiya, 3 (11), 7–16. Available at: http://reproduct-endo.com.ua/pdf/11/7_16.pdf
Koshel, A. P. (2014). Cytoreductive (Palliative) operations and reconstructive surgery: pro et contra. Voprosy rekonstruktivnoy i plasticheskoy hirurgii, 4 (51), 6–8. Available at: http://journals.tsu.ru/uploads/import/1181/files/_4__2014_8.pdf
Ametov, A. S. (2009). Izbrannye lekcii po endokrinologii. Moscow: MIA, 496.
Bjorge, T., Stocks, T., Lukanova, A., Tretli, S., Selmer, R., Manjer, J. et. al. (2010). Metabolic Syndrome and Endometrial Carcinoma. American Journal of Epidemiology, 171 (8), 892–902. doi: 10.1093/aje/kwq006
Belyaeva, O. D. (2011). Metabolicheskiy sindrom u bol'nyh abdominal'nym ozhireniem: klinicheskie i molekulyarno-geneticheskie aspekty. Saint Petersburg, 377.
Hwang, L. C., Bai, C. H., Sun, C. A., Chen, C. J. (2012). Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan. Asia Pacific Journal of Clinical Nutrition, 21 (2), 227–233.
Salgado, A. L. F. de A., Carvalho, L. de, Oliveira, A. C., Santos, V. N. dos, Vieira, J. G., Parise, E. R. (2010). Insulin resistance index (HOMA-IR) in the differentiation of patients with non-alcoholic fatty liver disease and healthy individuals. Arquivos de Gastroenterologia, 47 (2), 165–169. doi: 10.1590/s0004-28032010000200009
Dedov, Y. Y., Shestakova, M. V. (Eds.) (2011). Saharnyy diabet. Diagnostika, lechenie, profilaktika. Moscow: MIA, 801. Available at: http://kingmed.info/knigi/Endokrinologia/book_2773/Saharniy_diabet_Diagnostika_llecheni_profilaktika-Dedov_II_Shestakova_MV-2011-djvu
Buchwald, H., Estok, R., Fahrbach, K., Banel, D., Jensen, M. D., Pories, W. J. et. al. (2009). Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis. The American Journal of Medicine, 122 (3), 248–256. doi: 10.1016/j.amjmed.2008.09.041
Grace, A., Chan, E., Giallauria, F., Graham, P. L., Smart, N. A. (2017). Clinical outcomes and glycaemic responses to different aerobic exercise training intensities in type II diabetes: a systematic review and meta-analysis. Cardiovascular Diabetology, 16 (1), 37. doi: 10.1186/s12933-017-0518-6
Chazova, Y. E., Michka, V. B. (2006). Otkrytaya, mnogocentrovaya, randomizirovannaya, nauchno-prakticheskaya programma MINOTAVR: promezhutochnyy analiz rezul'tatov. Kardiovaskulyarnaya terapiya i profilaktika, 2, 81–88.
Bluher, M. (2010). The distinction of metabolically “healthy” from “unhealthy” obese individuals. Current Opinion in Lipidology, 21 (1), 38–43. doi: 10.1097/mol.0b013e3283346ccc
Pischon, T., Boeing, H., Hoffmann, K., Bergmann, M., Schulze, M. B., Overvad, K. et. al. (2008). General and Abdominal Adiposity and Risk of Death in Europe. New England Journal of Medicine, 359 (20), 2105–2120. doi: 10.1056/nejmoa0801891
Bradshaw, P. T., Monda, K. L., Stevens, J. (2013). Metabolic syndrome in healthy obese, overweight, and normal weight individuals: The atherosclerosis risk in communities study. Obesity, 21 (1), 203–209. doi: 10.1002/oby.20248
Milicya, K. M., Lavrik, A. S., Lavrik, O. A. (2016). Omentektomiya kak citoreduktivnyy etap lecheniya metabolicheskogo sindroma pri simul'tannyh operaciyah. Hirurgiya Ukrainy, 4 (60), 49–54.
Coomarasamy, A., Shafi, M. I., Davila, G. W., Chan, K. K. (2016). Omental Procedures: Supracolic Omentectomy, Infracolic Omentectomy, Omental Biopsy. Gynecologic and Obstetric Surgery, 423–424. Available at: http://onlinelibrary.wiley.com/doi/10.1002/9781118298565.ch141/summary doi: 10.1002/9781118298565.ch141
Herrera, M. F., Pantoja, J. P., Velazquez-Fernandez, D., Cabiedes, J., Aguilar-Salinas, C., Garcia-Garcia, E. et. al. (2010). Potential Additional Effect of Omentectomy on Metabolic Syndrome, Acute-Phase Reactants, and Inflammatory Mediators in Grade III Obese Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass: A randomized trial. Diabetes Care, 33 (7), 1413–1418. doi: 10.2337/dc09-1833
Milleo, F. Q., Campos, A. C. L., Santoro, S., Lacombe, A., Santo, M. A., Vicari, M. R. et. al. (2011). Metabolic effects of an entero-omentectomy in mildly obese type 2 diabetes mellitus patients after three years. Clinics, 66 (7), 1227–1233. doi: 10.1590/s1807-59322011000700018
Boughton, B. (2011). Using Omentectomy With Gastric Bypass May Have Added Benefits. American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress. Available at: http://www.medscape.com/viewarticle/741801
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