{"id":117953,"date":"2018-03-11T10:47:44","date_gmt":"2018-03-11T10:47:44","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/senales-neurohormonales-tras-gastrectoma%c2%ada-tubular-y-by-pass-gastrico-implicacion-en-la-perdida-de-peso-y-resolucion-de-la-diabetes-mellitus-tipo-2\/"},"modified":"2018-03-11T10:47:44","modified_gmt":"2018-03-11T10:47:44","slug":"senales-neurohormonales-tras-gastrectoma%c2%ada-tubular-y-by-pass-gastrico-implicacion-en-la-perdida-de-peso-y-resolucion-de-la-diabetes-mellitus-tipo-2","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/hormonas\/senales-neurohormonales-tras-gastrectoma%c2%ada-tubular-y-by-pass-gastrico-implicacion-en-la-perdida-de-peso-y-resolucion-de-la-diabetes-mellitus-tipo-2\/","title":{"rendered":"Se\u00f1ales neurohormonales tras gastrectom\u00edatubular y by-pass g\u00e1strico. implicaci\u00f3n en la p\u00e9rdida de peso y resoluci\u00f3n de la diabetes mellitus tipo 2"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Mar\u00eda  Inmaculada Navarro Garcia <\/strong><\/h2>\n<p>Palabras clave: cirug\u00eda bariatrica.Gastrectom\u00eda tubular laparosc\u00f3pica.Bypass g\u00e1strico laparosc\u00f3pico. p\u00e9rdida de exceso de peso.Diabetes mellitus. hormonas gastrointestinales.Ghrelina.Glp-1.Pyy.  se\u00f1ales neurohormonales tras gastrectom\u00eda tubular y by-pass g\u00e1strico.Implicaci\u00f3n en la p\u00e9rdida de peso y resoluci\u00f3n de la diabetes mellitus tipo 2.   objetivo \tnuestro objetivo fue comparar la t\u00e9cnica gastrectom\u00eda tubular (gt) con el by-pass g\u00e1strico (bp),en cuanto a la p\u00e9rdida ponderal y resoluci\u00f3n de comorbilidades. Analizando los marcadores del s\u00edndrome metab\u00f3lico y las modificaciones hormonales en ayunas con ambos procedimientos. material y m\u00e9todo \tel estudio se realiz\u00f3 en el servicio de cirug\u00eda general del complejo hospitalario de cartagena,entre 2011-2013 y un seguimiento de 24 meses.Estudio observacional de cohortes anal\u00edticas prospectivo consecutivo,donde se dise\u00f1aron dos grupos de estudio distribuidos de forma no aleatoria: grupo a (100 pacientes bp),y grupo b (100 pacientes gt).Los criterios de inclusi\u00f3n fueron los utilizados por la sociedad espa\u00f1ola de cirug\u00eda de la obesidad (seco).La asignaci\u00f3n de los pacientes a un determinado grupo se realiz\u00f3 siempre en el mismo orden y seg\u00fan fecha de inclusi\u00f3n en lista de espera quir\u00fargica.  \ten el protocolo de estudio de incluyeron:datos demogr\u00e1ficos (edad y sexo); variables cl\u00ednicas preoperatorias (peso, talla, peso ideal, \u00edndice de masa corporal (imc),comorbilidades asociadas (diabetes mellitus tipo 2,hipertensi\u00f3n arterial,s\u00edndrome de apnea obstructiva del sue\u00f1o y dislipemias),riesgo anest\u00e9sico); variables quir\u00fargicas (tiempo,conversi\u00f3n,complicaciones intraoperatorias,precoces y tard\u00edas,mortalidad) y seguimiento (peso,porcentaje de sobrepeso perdido (psp),imc y porcentaje de exceso de imc perdido (peimcp) evaluado a 1,3,6,12,18 y 24 meses.La resoluci\u00f3n de comorbilidades se midi\u00f3 al a\u00f1o bas\u00e1ndose en valores anal\u00edticos y en la no toma de medicaci\u00f3n. Las determinaciones anal\u00edticas se realizaron en el preoperatorio, 5\u00c2\u00bad\u00eda, 1\u00c2\u00bames, 6\u00c2\u00bames y 12\u00c2\u00bameses,y fueron: hemoglobina glicosilada (hba1c),glucosa, colesterol total, hdl-colesterol, ldl-colesterol,triglic\u00e9ridos,aspartato aminotransferasa (ast),alanina aminotransferasa (alt),gamma-glutamiltransferasa (ggt),fosfatasa alcalina (fa),proteina c reactiva (pcr),interleuquina 6 (il-6),\u00edndice de resistencia insul\u00ednica (homa),insulina y p\u00e9ptido c.Se complement\u00f3 un an\u00e1lisis hormonal en 54 pacientes (27 bp vs. 27 gt),midiendo ghrelina acilada,glp-1 activa y pyy total en ayunas,utilizando un panel metab\u00f3lico humano dise\u00f1ado para el estudio de biomarcadores (milliplex\u00c2\u00bf map). conclusiones \tla gastrectom\u00eda tubular present\u00f3 un tiempo operatorio significativamente menor que el by-pass g\u00e1strico,con un porcentaje de complicaciones precoces similar.En cambio,cuando se produce una complicaci\u00f3n precoz en la gastrectom\u00eda tubular,suele tener un mayor \u00edndice de clavien.Las complicaciones tard\u00edas son m\u00e1s frecuentes en el by-pass g\u00e1strico,destacando en nuestro estudio la estenosis de la anastomosis gastroyeyunal.  \tel by-pass g\u00e1strico present\u00f3 un psp significativamente mayor que la gastrectom\u00eda tubular al mes,tres,seis,doce,dieciocho y veinticuatro meses de seguimiento.A los dos a\u00f1os, ambas t\u00e9cnicas alcanzaron un psp del 65%. \tal a\u00f1o de seguimiento,no hubo diferencias en la resoluci\u00f3n de diabetes mellitus tipo 2,hipertensi\u00f3n arterial,s\u00edndrome de apnea obstructiva del sue\u00f1o y dislipemias entre ambas t\u00e9cnicas quir\u00fargicas.La gastrectom\u00eda tubular resolvi\u00f3 el 77% de la diabetes mellitus tipo 2 frente al 68% del by-pass g\u00e1strico. \tcon ambas t\u00e9cnicas encontramos un descenso significativo en los niveles de triglic\u00e9ridos y transaminasas,y un ascenso en los niveles de hdl colesterol.S\u00f3lo en el by-pass g\u00e1strico se aprecia un descenso de colesterol total y ldl colesterol.La pcr descendi\u00f3 con ambas t\u00e9cnicas,si bien el descenso s\u00f3lo fue significativo con el by-pass g\u00e1strico. \tobservamos un incremento de los valores de ghrelina acilada en ayunas al a\u00f1o con ambas t\u00e9cnicas quir\u00fargicas,en respuesta a una p\u00e9rdida ponderal del 30%. No encontramos correlaci\u00f3n lineal negativa entre ghelina acilada, imc e insulina. \tno hay modificaciones de glp-1 activa en ayunas al a\u00f1o con ninguna de las dos t\u00e9cnicas quir\u00fargicas,si bien al 5\u00c2\u00bad\u00eda postoperatorio se observa un descenso significativo con ambas. \tel pyy total en ayunas al a\u00f1o aument\u00f3 significativamente con ambas t\u00e9cnicas quir\u00fargicas.La elevaci\u00f3n fue mayor en el grupo de gastrectom\u00eda tubular,si bien la diferencia con el by-pass g\u00e1strico no fue significativa. palabras: 595      key words: bariatric surgery.Laparoscopic sleeve gastrectomy.Laparoscopic gastric bypass. excess weight loss.Diabetes mellitus.  gastrointestinal hormones.Ghrelin.Glp-1.Pyy.  neurohormonales signals after sleeve gastrectomy and gastric by-pass. Involvement in weight loss and resolution of diabetes mellitus type 2. objetive \tour objective was to compare the technical sleeve gastrectomy (sg) with the gastric by-pass (gb),in terms of weight loss and resolution of comorbidities.Analysis of markers of metabolic syndrome and the hormonal changes in fasting with both procedures. material and method \tthe study was carried out in the service of general surgery of the hospital complex of cartagena,between 2011-2013 and followed for 24 months.Observational cohort study of analytical prospective consecutive,are designed where two study groups distributed not randomly:group a (100 patients gb), and group b (100 patients sg).The inclusion criteria were used by the spanish society of obesity surgery (seco).The allocation of patients to a particular group was always in the same order and according to date of inclusion in surgical waiting list. \tin the study protocol of included:demographic data (age and sex);preoperative clinical variables (weight,height,ideal weight,body mass index (bmi),associated comorbidities (diabetes mellitus type 2,high blood pressure,syndrome of obstructive apnea of the dream and dyslipidemia),anesthetic risk);surgical variables (time,conversion,intraoperative,early and late complications,mortality) and follow-up (weight,percentage of excess weight lost (%ewl),bmi and percentage of excess bmi lost (%ebmil) evaluated at 1,3,6,12,18 and 24 months.The resolution of comorbidities was measured per year based on analytical values and not taking medication.The analytical determinations were performed preoperatively,5th day,1 month,6 months and 12 months,and were: hemoglobin glycosylated (hba1c),glucose,total cholesterol,hdl-cholesterol,ldl-cholesterol,triglycerides,aspartate aminotransferase (ast),alanine aminotransferase (alt),gamma-glutamiltransferasa (ggt),alkaline phosphatase (ap),c-reactive protein (crp),interleukin 6 (il-6),index of insulin resistance (homa), insulin and c-peptide.Complemented a hormonal analysis in 54 patients (27 gb vs. 27 sg),measuring ghrelin acylated, glp-1 active and total pyy in fasting,using a human metabolic panel designed for the study of biomarkers (milliplex \u00c2\u00bf map).  conclusions \tsleeve gastrectomy presented an operative time significantly lower than the gastric bypass, with a similar percentage of early complications.On the other hand, when an early complication in sleeve gastrectomy, usually have a higher rate of clavien.Late complications are most frequent in the gastric bypass,highlighting the gastrojejunal anastomosis stenosis in our study. \tthe gastric bypass presented a %ewl significantly greater than the sleeve gastrectomy per month,three,six,twelve,eighteen and twenty-four months of follow-up.At age two, both techniques achieved a 65%ewl. \ta year of follow-up,there was no difference in the resolution of diabetes mellitus type 2,high blood pressure,syndrome of obstructive apnea of the dream and dyslipidemias among both surgical techniques.Sleeve gastrectomy met 77% of diabetes mellitus type 2 compared to 68% of the gastric bypass. \twith both techniques are a significant decrease in the levels of triglycerides and transaminases, and a rise in the levels of hdl-cholesterol.Only on the gastric bypass is shown a decline in total cholesterol and ldl-cholesterol.The crp came down with both techniques, although the decline was significant only with the gastric bypass. \twe observe an increase of the values of acylated ghrelin in fasting a year with both technical surgical, in response to a weight loss of 30%.Found no negative linear correlation between ghelina acylated, bmi and insulin. \tthere is no active glp-1 changes in fasting a year with none of the two surgical techniques,while the 5th postoperative day is observed a significant decrease in both. \tthe total pyy in fasting a year increased significantly with both surgical techniques.Elevation was greater in the group of sleeve gastrectomy,while the difference with the gastric bypass was not significant. palabras: 566<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Se\u00f1ales neurohormonales tras gastrectom\u00edatubular y by-pass g\u00e1strico. implicaci\u00f3n en la p\u00e9rdida de peso y resoluci\u00f3n de la diabetes mellitus tipo 2<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Se\u00f1ales neurohormonales tras gastrectom\u00edatubular y by-pass g\u00e1strico. implicaci\u00f3n en la p\u00e9rdida de peso y resoluci\u00f3n de la diabetes mellitus tipo 2 <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Mar\u00eda  Inmaculada Navarro Garcia <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 24\/07\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Mar\u00eda  Jes\u00fas Periago Caston<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: pascual Parrilla paricio <\/li>\n<li>francis Navarro (vocal)<\/li>\n<li>  (vocal)<\/li>\n<li>  (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Mar\u00eda Inmaculada Navarro Garcia Palabras clave: cirug\u00eda bariatrica.Gastrectom\u00eda tubular laparosc\u00f3pica.Bypass g\u00e1strico laparosc\u00f3pico. p\u00e9rdida de exceso de peso.Diabetes [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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