腹腔镜Roux-en-Y胃旁路手术治疗肥胖症和2型糖尿病  

Treatment of obesity and type 2 diabetes mellitus by laparoscopic Roux-en-Y gastric bypass

作　　者：杨景哥[1] 王存川[1] 胡友主[1] 李进义[1] 潘运龙[1] 沈莹莹[1] 黎泳欣[1] 黄璟[1] 俞春亮[1] 刘贤明[1] 

机构地区：[1]暨南大学附属第一医院胃肠外科,广州510630

出　　处：《中华胃肠外科杂志》2010年第8期594-597,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 探讨腹腔镜Roux-en-Y胃旁路手术（LRYGB）治疗肥胖症和（或）2型糖尿病的可行性及疗效.方法 对21例单纯性肥胖症及9例2型糖尿病患者施行LRYGB,观察肥胖症患者体质量、BMI、超重体质量减少率（EWL%）改善情况;观察糖尿病患者术后的空腹血糖和口服葡萄糖耐量试验（OGTT）变化情况;观察全组患者手术时间、术中出血量、术后恢复、术后并发症情况.结果 本组30例皆成功完成手术,无中转开放手术者,手术时间110～270（平均168）min.术中出血量10～75（平均24.0）ml.本组21例单纯性肥胖症患者术前体质量及BMI分别为（97.2±15.0）kg和35.3±3.5;术后随访2个月至5年,术后1个月体质量及BMI即显著下降[（85.1±10.1）kg和31.2±2.2,均P〈0.01],至术后2～3年降至最低水平[（66.8±9.2）kg和24.3±1.1],之后维持在此水平;EWL%则相应增高（均P〈0.05）.9例2型糖尿病患者术前空腹血糖及OGTT 2 h血糖分别为（12.6±2.6）mmol/L和（17.8±4.1）mmol/L;术后随访3～8个月,空腹血糖及OGTT2 h血糖均显著下降[（5.9±1.4）mmol/L和（7.8±1.4）mmol/L,均P〈0.05];其中合并肥胖症的4例患者BMI明显降低（P〈0.05）,而5例未合并肥胖症者BMI无明显变化（P〉0.05）.本组30例患者中5例（16.7%）术后出现并发症,其中1例因急性暴发性胰腺炎死亡外,1例因肠系膜裂孔疝致肠梗阻行再次手术治愈,余3例均经保守治疗治愈.结论 LRYGB治疗肥胖症和（或）2型糖尿病手术安全可行,术后近期减重和（或）降糖效果显著.Objective To investigate the efficacy of laparoscopic Roux-en-Y gastric bypass （LRYGB）in the treatment for obesity and type 2 diabetes mellitus（DM）.Methods Twenty-one cages of obesity and 9 cases of type 2 DM received the LRYGB.Weigh changes,excess body weight lose rate （EWL%）and blood glucose level were measured after surgery and occurrence of complications was observed postoperatively.Results LRYGB procedures in all the 30 cases were successfully performed with no conversion to open surgery.Average operation time was 168 minutes（110-270 mins）,volume of blood loss during the surgery was 24.0 ml（10-75 ml）.Twenty-one cases of simple obesity received follow-up from 2 months to 5 years.Body weight and BMI decreased significantly in one month[（85.1±10.1）kg vs（97.2±15.0）kg,31.2±2.2 vs 35.3±3.5,both P〈0.01]and to a minimal level in 2 to 3 years [（66.8±9.2）kg,24.3±1.1],and then maintained at this level.EWL%was correspondingly higher（all P〈0.05）.Nine type 2 DM patients were followed up for 3 to 8 months,fasting blood glucose and blood glucose OGTT2 hours decreased significantly[（5.9±1.4）mmol/L vs（12.6±2.6）mmol/L,（7.8±1.4）mmol/L vs（17.8±4.1）mmol/L,both P〈0.05],of whom 4 patients with obesity decreased in BMI significantly（P〈0.05）,and 5 patients without obesity had no significant changes in BMI（P〉0.05）.Five cases（16.7%） had postoperative complications,including 1 case of death due to acute fulminant pancreatitis,1 case of mesenteric hiatal hernia with obstruction in line for reoperation,and the other 3 cases of healing by conservative therapy.Conclusions Treatment of obesity and type 2 DM by LRYGB surgery is feasible with significant short term result.Long term outcome needs further observation.

关 键 词：胃旁路术 腹腔镜 肥胖症 2型糖尿病 

分 类 号：R656[医药卫生—外科学] R587[医药卫生—临床医学]