胃旁路术对非肥胖型2型糖尿病疗效的前瞻性对照研究  

Prospective controlled clinical study on gastric bypass surgery for nonobese type 2 diabetes mellitus

作　　者：魏炜明[1] 胡旭光[1] 陈丹磊[1] 印慨[1] 柯重伟[1] 郑成竹[1] 

机构地区：[1]第二军医大学附属长海医院微创外科,上海200433

出　　处：《中华消化外科杂志》2011年第3期206-209,共4页Chinese Journal of Digestive Surgery

摘　　要：目的探讨胃旁路术对非肥胖型2型糖尿病（T2DM）的疗效。方法前瞻性研究2008年11月至2009年8月第二军医大学附属长海医院收治的40例胃部疾病合并非肥胖型T2DM患者的临床资料，按实用性随机对照原则将患者分为4组，每组10例，分别接受毕Ⅰ式远端胃切除＋胃十二指肠吻合术（BI组）、近端胃大部切除＋食管残胃吻合术（PG组）、全胃切除＋Y型吻合术（RY组）、毕Ⅱ式胃空肠吻合术（BⅡ组），后2种术式为胃旁路术。比较4组患者住院时间、胃部疾病治疗情况、手术前后体质指数、腰围、空腹血糖、糖化血红蛋白、空腹血清胰岛素和空腹c肽水平等指标。数据采用方差分析、LSD—t检验、配对t检验、X2检验进行分析。结果4种术式对胃部疾病的疗效基本相同。RY组患者术前、术后6个月空腹血糖分别为（8．0±2．9）、（5．9±0．7）mmol／L，两者比较，差异有统计学意义（t=2．342，P〈0．05）。RY组患者术前糖化血红蛋白、空腹C肽分别为7．7％±1．1％、（1．30±0．54）μg/L，术后2、6个月分别为6．9％±0．6％、（1．95±0．86）μg／L和6．1％±0．4％、（2．18±0．63）μg／L，与术前比较，差异有统计学意义（t=4．920、6．063，3．012、4．651，P〈0．05）。RY组患者术前空腹血清胰岛素为（11±4）mU／L，术后1、2、6个月分别为（18±5）、（19±3）、（21±3）mU／L，与术前比较，差异有统计学意义（t=3．158，4．502，7．517，P〈0．05）。BⅡ组患者术前空腹血糖、糖化血红蛋白、空腹血清胰岛素和空腹血清c肽分别为（8．3±1．3）mmol／L、7．7％±0．9％、（13±4）mU／L、（1．34±0．48）μg/L，术后1、2、6个月分别为（6．7±1．2）mmol／L、6．8％±0．8％、（18±4）mU／L、（1．68±0．46）μg/L和（6．4±1．3）mmol／L、6．3％±0．6％、（18±4）mU／L、（1．96±0．67）μg／L及（5．6�Objective To investigate the efficacy of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus. Methods From November 2008 to August 2009, 40 patients with gastric diseases and nonobese type 2 diabetes mellitus were admitted to the Changhai Hospital, and their clinical data were prospectively studied. All patients were randomly divided into 4 groups： 10 patients received Billroth I distal gastrectomy ＋ gastroduodenal anastomosis （B I group）, 10 received proximal gastrectomy ＋ remanant gastric esophageal anas- tomosis （PG group ）, 10 received total gastrectomy ＋ esophagoduodenal Y-anastomosis （RY group ） and 10 received subtotal gastrectomy Billroth Ⅱ gastro-jejunostomy （ B Ⅱ group）. The length of hospital stay, pre- and postoperative body mass indexes （BMIs）, waist circumferences, levels of fasting blood glucose （FBG）, glycated hemoglobin （ GHbA1 ）, fasting serum insulin （FSI） and fasting C-peptide （FCP） of patients in the 4 groups were compared. All data were analyzed using analysis of variance, LSD-t test, paired t test or chi-square test. Results The clinical effects of the 4 different operative procedures on the gastric diseases were similar. The levels of FBG were （ 8.0 ±2.9 ） mmol/L before operation and （5.9±0.7 ） mmol/L after operation in the RY group, with a significant difference （t = 2. 342, P 〈 0. 05 ）. The preoperative level of GHbAI in the RY group was 7.7% ±1.1% , which was significantly higher than 6.9%±0.6% at 2 months after the operation and 6.1%±0.4% at 6 months after the operation （t =4. 920, 3. 012, P 〈0.05）. The preoperative level of FCP in the RY group was （ 1.30± 0.54）μg/L, which was significantly lower than （ 1.95± 0.86）μg/L at 2 months after the operation and （2.18 ± 0.63 ）μg/L at 6 months after the operation （ t = 6. 063, 4. 651, P 〈 0.05）. The levels of FSI in the RY group at postoperative month 1, 2 and 6 were （ 18 ± 5 ）, （ 19± 3 ）, （ 21 ± 3 ） mU/L, wh

关 键 词：糖尿病 2型 胃旁路术 临床对照研究 非肥胖型 

分 类 号：R587.1[医药卫生—内分泌]