小腸繞道-安和美醫美外科診所

小腸繞道

內容目錄

夏季的腳步越來越近，厚重衣物收起、輕薄短衫上場，身形曲線立馬現形，一旦對美食缺乏克制力，往往不知不覺吃進過多食物而難以消「瘦」。對於試過各種減重方式屢屢失敗，甚至自嘲連呼吸、喝水都會胖的人，最後都不得不尋求手術方式改善。

安和美醫美診所丁姓醫師指出，減重手術多元，選擇安全、有效、住院時間短、對生活習慣及口腹之慾干擾最少、對代謝疾病有效又不易復胖的方式，是現代的趨勢。安和美醫美診所丁姓醫師表示，小腸繞道手術在臨床實驗上，證實對降低食物吸收有效，手術後食量不受影響，加上胃部與食道連結處並未被截斷，日後若反悔，可以再進行手術回復原狀。正因為胃部和十二指腸的功能皆保留，不像傳統胃繞道手術及其它減重手術後，必須長期補充礦物質和維他命，否則皮膚容易失去光澤、或是出現掉髮甚至貧血等現象，相對於其他減重手術，小腸繞道手術安全性高、副作用也低，減重不用那麽累，讓患者不須有過多擔心的減重手術才是首選。

安和美醫美外科診所丁醫師表示，小腸繞道手術與傳統胃繞道手術和其它減重手術略有差異，傳統胃繞道手術是將胃和食道連結部位截斷，將食道接到小腸，讓胃逐漸縮小失去作用；小腸繞道手術則不將胃和食道截斷，採另闢一條新路徑的作法，將小腸接到小腸，讓食物直接從近端進入遠端小腸，不經過大部分的小腸吸收消化作用，使食物吸收率大幅下降，長期下來在胃容量和食量皆不受影響的狀況下，也能輕鬆達到瘦身的目的。

目前大部分減重手術仍會影響胃容量及食量，但常聽到患者因飢餓難耐，體重又回到原點。丁斌煌醫師指出，有些胃部切除縮小或傳統胃繞道手術患者，術後進食量被迫突然驟減，對於平時食量大、嗜美食者，從原先兩碗飯變成只能吃半碗，初期通常能盡力配合，但時間一久難以忍受，很容易就恢復到原本的食欲，不僅無法達到預期效果，減重計畫也徹底破功了。

安和美醫美診所丁醫生說明，小腸繞道手術機轉並非減少進食量，或減少「口腹之慾」，經過小腸繞道手術，在保留胃部功能後，主要作用在減少小腸吸收，至於減少吸收的多寡及減重的效果，關鍵在於醫師如何評估繞道的近端及遠端部位，及繞道距離的長短，並不是越遠越好，這需要根據豐富的專業經驗及實際臨床個案的判斷才能精準，因此選擇手術經驗豐富的專業醫師執刀尤其重要。

安和美醫美診所丁醫師建議，BMI值過重、食欲太好或體重過重已影響到情緒和睡眠，抑或是長期吃減肥藥、抽脂多次，甚至進食量也不多，卻仍然瘦不下來的人，可以考慮小腸繞道手術。他也提醒，施行對象必須為20歲以上的成年人，孕婦不宜，心血管和糖尿病患者應待醫師評估後再決定。

減重手術種類	傳統胃繞道	胃袖狀切除(胃縮小)	可調整胃束帶手術
原理	減少吸收，胃容量明顯改變，需限制進食	胃容量明顯改變，需限制進食	胃容量明顯改變，需限制進食
減重效果	佳	佳	較差
優缺點	1.胃容量明顯改變，須極度限制飲食量，患者易因此感到不適應 2.營養素吸收不完全，需長期補充鐵、鈣、葉酸、維他命B群等營養素 3.與縮胃手術相比，較不會產生胃食道逆流的情形	1.胃容量明顯改變，須極度限制飲食量，患者易因此感到不適應 2.胃一旦切除無法再回復 3.術後可能會有胃食道逆流的情形 4.較傳統胃繞道手術安全	1.胃容量明顯改變，須極度限制飲食量，患者易因此感到不適應 2.減重速度較慢 3.復胖率高 4.較無年齡限制，14～65歲，都可以做
維生素缺乏	需積極補充維他命，造成生活上的不方便	輕微缺乏維他命	輕微缺乏維他命

減重手術種類	安和美小腸繞道加強型+新式胃繞道	安和美小腸繞道加強型	安和美小腸繞道(非傳統型)	安和美新式胃繞道
原理	減少吸收，稍微改變胃容量	減少吸收，不影響胃容量	減少吸收，不影響胃容量	減少吸收，稍微改變胃容量
減重效果	超優	特優	特優	優
優缺點	1.具可逆性，若日後反悔可再手術恢復原狀 2.鮮少復胖 3.減重效果優異且快 4.胃功能仍保留 5.費用較高	1.復胖率低 2.減重效果佳且快 3.在不影響胃容量及食量的前提下，仍有減重效果 4.具可逆性，若日後反悔可再手術恢復原狀	1.在不影響胃容量及食量的前提下，仍有減重效果 2.具可逆性，若日後反悔可再手術恢復原狀 3.費用較小腸加強型及新式胃繞道低	1.胃功能仍保留 2.具可逆性，若日後反悔可再手術恢復原狀 3.費用較小腸繞道高
維生素缺乏	不須額外補充維他命	不須額外補充維他命	不須額外補充維他命	不須額外補充維他命

減重效果

小腸繞道手術後，若以超過理想體重的部份來計算（理想體重以BMI=22計算之），術後第一年平均可減去65％的超重體重，第二年可減去75％；而在第二至第三年時達到最低點並保持下去，部分患者會有些許的體重回升，但不至於升回至原來的體重。

安全性

此一手術的致死率為0.3％，合併症則為5％（包括吻合處滲漏，腸阻塞，傷口感染等）；如此安全的手術數據是由合格的減重手術醫師所呈現的。

優點(相較於傳統減重手術)

(1) 較少掉髮現象。
(2) 胃口不受影響。
(3) 不需要長期補充維他命。
(4) 肥胖型糖尿病改善效果佳。
(5) 手術當天即可下床走動和出院。
(6) 不管體重多重皆可和醫師討論施做手術。
(7) 可以利用特殊縫合技術，順道切除多餘脂肪，使腹部更緊緻。

小腸繞道術後注意事項

(1)手術後盡量早期下床活動，可幫助引流管的液體排出，加速術後身體機能的恢復。
(2) 傷口引流管須觀察三天到一週，於拆線時拔除。
(3) 術後前半個月須以流質食物為主，半個月後調整為半流質，一個月後就可恢復正常飲食，每餐建議六分飽即可，或採少量多餐，仍建議飲食均衡勿暴飲暴食，如此有助傷口盡速癒合。

術後飲食原則

第一階段：清流質飲食(術後1-7天)

不含渣的液體食物，如:水、運動飲料、清澈蔬果汁、米湯、魚肉清湯。
避免飲食：術後前一週內避免牛奶豆漿，以免引起脹氣不適；避免酒精飲料，氣泡飲料，含咖啡因飲料，注意不可大量飲用食物。
營養師的小秘訣 : 初期可使用吸管進食少量液體，每口30 -50c c，每天補充水分1000 -1500m l，可隨身攜帶水壺，若感到全身無力，可少量補充糖果。

第二階段：全流質飲食(術後8-14天)

將煮熟的固體食物放入果汁機攪拌成流質，如濃湯、蛋花湯、嫩豆腐，如果直接進食，需小口咀嚼食物至糜爛方可吞下。
避免食物 : 堅硬成形的食物、蔬菜水果等富含纖維的食物、碳酸飲料、辛辣、刺激的食物。
營養師的小秘訣 : 使用湯匙小口用餐，若感到肚子餓，進食少量含糖分的果汁或巧克力。

第三階段：半流質飲食(術後15-28天)

絞細或切碎的固體食物加入飲料或湯汁烹煮成粥、湯麵，再漸進至軟食，如水餃，術後小腸吻合處需要6到8週才會癒合，所有的食物選擇以清淡易消化為主。
避免食物 : 甜食、太甜或濃稠度太高的食物，如:冰淇淋、巧克力、辛辣、刺激性.、黏、脆、油炸、蔬菜水果等富含纖維或堅硬的食物。
營養師的小秘訣 : 蛋白質優先攝取，可以使用30cc的小杯子測量每次進食量，注意足夠的水份補充，需每天補充綜合維他命及鈣片。

第四階段：固體食物(手術1個月之後)

維持低脂肪高蛋白的飲食原則，儘量挑柔軟、容易消化的食物，避免過於飽食。
避免食物 : 甜食、含糖飲料、酒及高油脂食物。
營養師的小秘訣 : 飲食均衡可依身體的耐受性增加纖維質，注意足夠的水份補充，不可喝高糖飲料，可利用飯碗或咖啡碟計算進食量。

小腸繞道術後成功的秘訣

‧不能吃到吐，只吃正餐、不吃點心、避免進食時間過長，或是吃不停的習慣。
‧將食物切小塊，細嚼慢嚥、吃到微脹就要停止用餐。
‧飲食務必均衡，小腸繞道食物仍會經過十二指腸和近端空腸，維生素的吸收不減少，因此不需每日補充維它命。
‧每天量體重及規律的運動。

手術Q&A

◎ 手術前兩星期要停止服用的藥物?

術前兩星期要停止服用會影響凝血時間的藥物，例如：Aspirin（阿斯匹林）、類固醇或治療關節炎的止痛藥物，若還有服用其他任何藥物請告知你的醫生。

◎ 術後體重下降是否須要整形手術？

對於整形手術的需要與否有許多的影響因素，包括體重下降的程度、開刀前的體重及脂肪分布。年紀輕的病患皮膚彈性較好，因此較不需要進一步的整形手術來去除鬆弛的皮膚。

◎ 手術後是否可以懷孕生子？

可以，生育年齡的女性術後可以正常懷孕生子，全世界接受減重手術的病患已有數千位順利懷孕生產。不過，定期地門診追蹤檢驗維生素足量與否是非常重要的。

◎ 什麼是傾倒症候群？

傾倒症候群一般發生在做過傳統胃繞道手術、胃袖狀切除手術(縮胃)等胃部手術後的患者身上，通常會有腹脹、腹絞痛、噁心、嘔吐等腹部的症狀，甚至出現心悸、虛脫、盜汗、頭暈等不適情形，小腸繞道手術的優勢為不會有傾倒症候群的狀況發生。

◎ 手術後如果懷孕營養如何維持？

手術後最少滿3個月再懷孕較理想，若懷孕了須與減重手術醫師、婦產科醫師及營養師保持連繫。

以下為安和美醫美外科診所真實案例分享:

一位年近40歲的女性糖尿病患，體重70多公斤，常因抵擋不住美食的誘惑而控制不了體重，所幸經由小腸繞道手術後，糖化血色素從原本的8至10之間降到6，血糖獲得改善，術後兩、三個月體重也降至60公斤，健康減重成效頗佳。

小腸繞道手術術後不會有噁心，嘔吐等不適症狀，平均半年瘦超重部位的60%

Small Intestine Bypass -The Latest Smart Option Of Weight Loss Surgery

Weight loss surgery – how to make the right decision?

There are so many kinds of weight loss surgeries for people to choose now, the traditional surgical methods for example gastric bypass surgery ,sleeve gastrectomy and adjustable gastric banding surgery ,etc., but these surgical methods usually influence the space of stomach, after people had the operation, in the beginning people can only eat few food, it annoys the clients who had good appetite that they used to eat a lot of food before, but now we have better choice-small intestine bypass surgery.

How small intestine bypass surgery work?

Small intestine bypass surgery will not influence the space of stomach, AHM cosmetic surgery clinic’s dr. Ting said that it protects the stomach function, the main function is to reduce the absorption of the small intestine. As for the amount and effect of reducing the absorption of the small intestine, how to determine the location of the proximal and distal parts of the bypass and the distance of the bypass, this requires doctors to judge based on professional experience and clinical cases, so that it can be accurate and not go too far, not as far away as possible, and the mobile mechanician should be used to reduce the amount of food absorption, or reduce the "desire for appetite".

Small intestine bypass surgery has been proven to be effective in reducing food absorption in clinical trials, and it does not affect overeating after surgery. In addition, the connection between the stomach and esophagus has not been cut off. Because the functions of the stomach and duodenum are preserved, unlike traditional gastric bypass surgery and other weight loss procedures, minerals and vitamins must be supplemented for a long time, otherwise the skin may lose luster, or hair loss and other phenomena may occur. Small intestine bypass surgery is high safety, relatively low side effects.

Effect of small intestine bypass surgery

After small intestine bypass surgery, if the excess weight is calculated based on the excess weight (the ideal weight is calculated with BMI=22), the excess weight can be reduced by an average of 65% in the first year after surgery, and 75% in the second year ; And in the second to third year to reach the lowest point and maintain, some patients will have a little weight back, but not back to the original weight.

Advantages of small intestine bypass surgery

The fatality rate of this operation is 0.3%, and the complication rate is 5% (including anastomotic leakage, intestinal obstruction, wound infection, etc.); such safe operation data are presented by qualified bariatric surgeons. Advantages (compared to traditional small bowel bypass)

(1) Less hair loss phenomenon.
(2) Appetite is not affected.
(3) Long-term vitamin supplementation is not required.
(4) Improvement for obese diabetic patients.
(5) You can get out of bed and walk on the day of the operation, and you can be discharged the next day.
(6) It can also be made within BMI30, and can be made by hand within 100 kg.
(7) Suture can be used to remove excess fat along the way to make the abdomen more compact.

Small intestine bypass surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, and it is typically done only after you've tried to lose weight by improving your diet and exercise habits.

Principles of diet after surgery

The first stage: Clear liquid diet (1-7 days after surgery)

Liquid foods without residue, such as: water, sports drinks, clear vegetable juices, rice soup, fish broth.

Diet to avoid: Avoid milk and soy milk within the first week after surgery, so as not to cause flatulence and discomfort; avoid alcoholic beverages, sparkling beverages, and caffeinated beverages, and be careful not to drink a lot of food. Nutritionist's tips: At the beginning, you can use a straw to eat a small amount of liquid, 30-50c per mouthful, and replenish 1000-1500ml of water per day. You can carry a water bottle with you. If you feel weak, you can add a small amount of candy.

The second stage: full liquid diet (8-14 days after surgery)

Put the cooked solid food into a juicer and stir it into a liquid, such as thick soup, egg drop soup, tender tofu, vegetable puree, fruit juice. If you eat it directly, you need to chew the food until it rots before swallowing.
Diet to avoid : Hard formed foods, carbonated drinks, spicy, irritating foods. Nutritionist's tips: Use a spoon to eat small meals, and if you feel hungry, eat a small amount of sugary fruit juice or chocolate.

The third stage: semi-liquid diet (15-28 days after surgery)

Ground or chopped solid food is added to drink or soup to cook porridge and noodle soup, and then gradually to soft food, such as dumplings. It takes 6 to 8 weeks for the gastrectomy anastomosis to heal after surgery. All food choices should be light and easy. Mainly digestion.
Diet to avoid: Sweets, foods that are too sweet or too thick, such as: ice cream, chocolate, spicy, pungent, sticky, brittle, fried or hard foods. Nutritionist's tips: Prioritize intake of protein. You can use a small 30cc cup to measure the amount of food you eat each time. Pay attention to adequate water intake. You need to supplement with multivitamins and calcium tablets every day. Do not eat with soup or high-sugar foods. Avoid dumping syndrome.

The fourth stage: Solid food (1 month after surgery)

Maintain a low-fat, high-protein diet, try to pick soft, easy-to-digest foods, and avoid overeating.
Diet to avoid: sweets, sugary drinks, alcohol and fatty foods. Nutritionist's tips: A balanced diet can increase fiber according to the body's tolerance, pay attention to adequate water supplementation, do not drink high-sugar beverages, and use rice bowls or coffee saucers to calculate food intake.

Why you should choose AHM cosmetic surgery clinic?

Dr. Ting ,the director of AHM cosmetic surgery clinic has more than 20 years professional experience on bariatric surgery , cosmetic surgery ,plastic surgery, etc., small intestine bypass surgery is one of the surgeries that Dr. Ting is proud of. Through this surgery, we have helped many clients lose weight and regain their health. The clinic is located in Taipei, the capital of Taiwan. It takes only 40 minutes by taxi from the airport, and the transportation is very convenient , There are also many hotels near the clinic to stay in, which is the best choice for medical tourists.

案例分享