{"id":396,"date":"2014-10-18T12:44:00","date_gmt":"2014-10-18T12:44:00","guid":{"rendered":"http:\/\/www.papatyafunda.com\/?p=396"},"modified":"2020-09-24T23:31:16","modified_gmt":"2020-09-24T23:31:16","slug":"prof-dr-alp-gurkan","status":"publish","type":"post","link":"https:\/\/www.papatyafunda.com\/?p=396","title":{"rendered":"PROF. DR. ALP G\u00dcRKAN"},"content":{"rendered":"\n

OBEZ\u0130TE B\u0130R KADER DE\u011e\u0130L MUTLAKA TEDAV\u0130 ED\u0130LMES\u0130 GEREKEN B\u0130R HASTALIKTIR<\/p>\n\n\n\n

20. y\u00fczy\u0131l\u0131n 2. yar\u0131s\u0131nda ve 21. y\u00fczy\u0131lda \u00f6zellikle Bat\u0131 d\u00fcnyas\u0131nda refah artarken yiyece\u011fe eri\u015fim de kolayla\u015fm\u0131\u015f, yiyecek ucuzlam\u0131\u015f ayn\u0131 zamanda \u00e7e\u015fitlenmi\u015ftir. Bunun yan\u0131nda h\u0131zl\u0131 ya\u015fam ko\u015fullar\u0131n\u0131n getirdi\u011fi \u201cfast food\u201dlar, televizyon ile ba\u015flayan t\u00fcm gece at\u0131\u015ft\u0131rmalar\u0131 ve yiyecek al\u0131\u015fkanl\u0131klar\u0131m\u0131zda de\u011fi\u015fiklikle beraber t\u00fcm d\u00fcnyada fazla kilolar\u0131 da beraberinde getirmi\u015ftir. Sa\u011fl\u0131ks\u0131z yeme al\u0131\u015fkanl\u0131\u011f\u0131, kimyasal madde ve hormon i\u00e7erikli g\u0131dalar ile g\u00fcnl\u00fck aktivitenin azalmas\u0131 v\u00fccutta giderek a\u015f\u0131r\u0131 miktarda ya\u011f depolanmas\u0131yla sonu\u00e7lanmaktad\u0131r. V\u00fccutta a\u015f\u0131r\u0131 ya\u011f depolanmas\u0131 olarak da nitelenebilecek duruma obezite denmektedir.<\/p>\n\n\n\n

Obez ki\u015filerin ya\u015f\u0131tlar\u0131na g\u00f6re ortalama 12 y\u0131l daha k\u0131sa ya\u015fad\u0131\u011f\u0131na dikkat \u00e7eken Medicana \u00c7aml\u0131ca Hastanesi Genel Cerrahi Uzman\u0131 Prof. Dr. Alp G\u00fcrkan; \u201cObezite \u015feker hastal\u0131\u011f\u0131 (tip 2 diyabet), kalp ve damar hastal\u0131klar\u0131, y\u00fcksek tansiyon, ya\u011f metabolizmas\u0131 bozukluklar\u0131, cinsel bozukluklar, eklem ve kemik problemler, uyku apnesi gibi bir\u00e7ok hastal\u0131\u011fa davetiye \u00e7\u0131kar\u0131r.<\/p>\n\n\n\n

Hatta meme kanseri, kal\u0131n barsak kanseri gibi kanser t\u00fcrlerinin de de obez hastalarda daha fazla g\u00f6r\u00fcld\u00fc\u011f\u00fc bilinmektedir. Obezite ki\u015filerin fizik g\u00f6r\u00fcn\u00fcmlerini bozmakta, buna ba\u011fl\u0131 olarak ruh sa\u011fl\u0131\u011f\u0131 ve sosyal ya\u015fam tehdit alt\u0131nda olmaktad\u0131r. Mutlaka tedavi edilmelidir.\u201d dedi.<\/p>\n\n\n\n

M\u0130DE BALONU<\/p>\n\n\n\n

Kilo vermeye yard\u0131mc\u0131 en basit y\u00f6ntem mide balon mide i\u00e7ine endoskop yard\u0131m\u0131yla, mide i\u00e7inde s\u0131v\u0131 veya hava doldurulan bir balon yerle\u015ftirilir. Hafif bir anestezi alt\u0131nda hastan\u0131n midesine bu balon yerle\u015ftirilir. Bu i\u015flem 15-20 dakika s\u00fcrer. B\u00f6ylece midenin g\u0131da alma kapasitesi d\u00fc\u015f\u00fcr\u00fcl\u00fcr ve \u00e7abuk doyma sa\u011flan\u0131r. Basit ve olduk\u00e7a d\u00fc\u015f\u00fck riskli bir y\u00f6ntem olmas\u0131na kar\u015f\u0131n, bu y\u00f6ntemin de ba\u015far\u0131 oran\u0131 d\u00fc\u015f\u00fckt\u00fcr. Bu y\u00f6ntemle hastalar birka\u00e7 ayda 7-8 kilo verebilirler.<\/p>\n\n\n\n

Ancak bu balon v\u00fccutta 6 ay, en fazla 1 y\u0131l kalabilir ve yine endoskopik yolla 5-6 dakika i\u00e7inde balon \u00e7\u0131kart\u0131l\u0131r. Basit uygulanmas\u0131 ve v\u00fccutta kal\u0131c\u0131 bir de\u011fi\u015fiklik olmamas\u0131 y\u00f6ntemin avantaj\u0131 olmakta birlikte, balon \u00e7\u0131kart\u0131ld\u0131ktan sonra hasta ya\u015fam \u015feklini de\u011fi\u015ftirmez ve diyetine devam etmezse verilen kilolar geri al\u0131nabilir. Ancak 6 ay-1 y\u0131ll\u0131k kullan\u0131m s\u00fcresi i\u00e7inde ki\u015filer nas\u0131l yemek yemeleri gerekti\u011fi konusunda deneyerek e\u011fitim alm\u0131\u015f olurlar.<\/p>\n\n\n\n

CERRAH\u0130 Y\u00d6NTEMLER<\/p>\n\n\n\n

Mide Kelep\u00e7esi (ayarlanabilir mide band\u0131)<\/p>\n\n\n\n

Laparoskopik (kapal\u0131) ameliyatlar\u0131n g\u00fcnl\u00fck kullan\u0131m\u0131n\u0131n yayg\u0131nla\u015fmas\u0131yla beraber bu y\u00f6ntem 15 y\u0131l \u00f6nce zay\u0131flama ameliyatlar\u0131nda da kullan\u0131lmaya ba\u015fland\u0131. Y\u00f6ntem; yemek borusunun mideye giri\u015f yerinin hemen alt\u0131nda mideyi bir kelep\u00e7e gibi s\u0131k\u0131\u015ft\u0131rd\u0131\u011f\u0131ndan halk aras\u0131nda \u201cmide kelep\u00e7esi\u201d diye an\u0131lmaktad\u0131r.<\/p>\n\n\n\n

Bu y\u00f6ntem de mideye g\u0131da al\u0131n\u0131m\u0131 k\u0131s\u0131tlayarak \u00e7al\u0131\u015f\u0131r. Ancak i\u015ftah azalmad\u0131\u011f\u0131 i\u00e7in insanlar g\u0131da alman\u0131n bir yolunu bulmaya \u00e7al\u0131\u015f\u0131rlar; dondurma veya bal gibi sulu ancak kalorisi bol g\u0131da t\u00fcketirler.<\/p>\n\n\n\n

\u0130stendi\u011fi zaman \u00e7\u0131kart\u0131lma ve v\u00fccutta kal\u0131c\u0131 de\u011fi\u015fiklik yapmamas\u0131 avantajl\u0131 g\u00f6r\u00fclse de uzun d\u00f6nem ba\u015far\u0131 oranlar\u0131 d\u00fc\u015f\u00fckt\u00fcr. Yani kelep\u00e7e kald\u0131\u011f\u0131 halde bile ki\u015filer kelep\u00e7eyi kand\u0131racak y\u00fcksek kalorili g\u0131dalar\u0131 t\u00fcketerek yeniden kilo almaya ba\u015flayabilirler.<\/p>\n\n\n\n

Mide T\u00fcp\u00fc (Sleeve Gastrectomy)<\/p>\n\n\n\n

En az di\u011fer komplike cerrahi y\u00f6ntemler kadar etkili ama yap\u0131l\u0131\u015f\u0131 di\u011ferlerinden daha kolay ve daha az sorunlu oldu\u011fu i\u00e7in son zamanlarda zay\u0131flama ameliyatlar\u0131nda en s\u0131k kulland\u0131\u011f\u0131m\u0131z y\u00f6ntemlerden biridir.<\/p>\n\n\n\n

Bu y\u00f6ntemde midenin %80-90 kadar\u0131 \u00e7\u0131kart\u0131larak mide bir t\u00fcp haline getirilir. Bu ameliyat da laparoskopik (kapal\u0131) y\u00f6ntemler 1-2 saatlik bir s\u00fcrede yap\u0131l\u0131r. Hastanede yat\u0131\u015f s\u00fcresi ise 2-3 g\u00fcnd\u00fcr.<\/p>\n\n\n\n

Ameliyat sonras\u0131nda hastalar 2 hafta s\u0131v\u0131, daha sonraki 2 hafta da yumu\u015fak g\u0131dalar t\u00fckettikten sonra kat\u0131 (normal) g\u0131daya ge\u00e7ebilirler. Vitamin takviyeleri gerekebilir.<\/p>\n\n\n\n

Midenin fundus dedi\u011fimiz b\u00f6lgesinden sal\u0131nan Ghrelin hormonunun \u015fi\u015fmanl\u0131ktan sorumlu oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n\n\n\n

Bu hormon ki\u015finin a\u00e7l\u0131k hissini kontrol eder.<\/p>\n\n\n\n

Bu ameliyat y\u00f6nteminde midenin fundus b\u00f6lgesi tamamen \u00e7\u0131kart\u0131larak ki\u015finin i\u015ftah\u0131n\u0131n azalmas\u0131 da zay\u0131flamas\u0131na yard\u0131mc\u0131 olur.<\/p>\n\n\n\n

Bu ameliyat sonras\u0131nda ki\u015filer 6 ay- 1y\u0131l i\u00e7inde gazla kilolar\u0131n\u0131n ortalama %80 kadar\u0131n\u0131 kaybederler. 1 y\u0131l i\u00e7inde de uyku apneleri ve diyabet gibi a\u015f\u0131r\u0131 kilolara ba\u011fl\u0131 sorunlar\u0131ndan kurtulurlar.<\/p>\n\n\n\n

BYPASS AMEL\u0130YATLARI<\/p>\n\n\n\n

Bu y\u00f6ntemlerde temel olarak midenin bir k\u0131sm\u0131n\u0131n kesilerek veya kesilmeden al\u0131nan g\u0131dalar\u0131n midenin hepsine veya b\u00fcy\u00fck bir k\u0131sm\u0131na, oniki parmak ba\u011f\u0131rsa\u011f\u0131na ve ince ba\u011f\u0131rsa\u011f\u0131n ilk b\u00f6l\u00fcmlerine u\u011framadan direkt olarak son k\u0131s\u0131mlar\u0131na gelmesi hedeflenir.<\/p>\n\n\n\n

Bu y\u00f6ntemler de g\u00fcn\u00fcm\u00fczde laparoskopik olarak ba\u015far\u0131yla uygulanmaktad\u0131r.<\/p>\n\n\n\n

Mide t\u00fcp\u00fc ameliyatlar\u0131na g\u00f6re bu y\u00f6ntemlerin hepsinde ameliyat komplikasyonlar\u0131 yan\u0131 s\u0131ra ameliyat sonras\u0131 uzun d\u00f6nemde metabolik sorunlar da daha fazlad\u0131r. Kilo kayb\u0131 daha fazlad\u0131r ve 2 y\u0131la kadar s\u00fcrebilir.<\/p>\n\n\n\n

T\u00fcm zay\u0131flama ameliyatlar\u0131nda temel olarak 2 mekanizma s\u00f6z konusudur: restriktif yani g\u0131da al\u0131n\u0131m\u0131n\u0131 k\u0131s\u0131tlay\u0131c\u0131 veya malabsorbtif yani emilimi engelleyici.<\/p>\n\n\n\n

Mide t\u00fcp veya bypass y\u00f6ntemlerinden herhangi biri bu 2 mekanizmay\u0131 beraber kulland\u0131klar\u0131ndan ki\u015filer gastrik band ameliyat\u0131nda oldu\u011fu gibi a\u00e7l\u0131k \u00e7ekerek de\u011fil, i\u015ftahlar\u0131 azalarak yani \u00e7abuk doyarak daha rahat bi\u00e7imde kilo vermektedirler.<\/p>\n\n\n\n

Obezitenin s\u0131n\u0131flamas\u0131<\/p>\n\n\n\n

G\u00fcn\u00fcm\u00fczde do\u011fruya en yak\u0131n ve \u00e7ok pratik olan v\u00fccut kitle<\/p>\n\n\n\n

indeksi (VK\u0130) denilen hesaplama y\u00f6ntemi kullan\u0131lmaktad\u0131r. Herkesin<\/p>\n\n\n\n

kolayl\u0131kla hesaplayabilece\u011fi form\u00fcl ki\u015finin a\u011f\u0131rl\u0131\u011f\u0131n\u0131n (kg. cinsinden)<\/p>\n\n\n\n

boyunun (metre cinsinden) karesine b\u00f6l\u00fcnmesiyle elde edilir.<\/p>\n\n\n\n

Amerikan Sa\u011fl\u0131k Enstit\u00fcs\u00fcne g\u00f6re;<\/p>\n\n\n\n

20 \u2013 24.9 ise normal<\/p>\n\n\n\n

25 \u2013 29.9 ise kilolu<\/p>\n\n\n\n

30 \u2013 34.9 ise obez<\/p>\n\n\n\n

34 \u2013 39.5 ise tip II obez<\/p>\n\n\n\n

40 \u2013 49.9 ise MORB\u0130D OBEZ<\/p>\n\n\n\n

50 ve \u00fczeri ise SUPER OBEZ diye kabul edilmektedir<\/p>\n\n\n\n