联合手术治疗胆囊结石合并2型糖尿病55例  

Combined surgical treatment of gallbladder stones with concomitant type 2 diabetes mellitus:a report of 55 cases

作　　者：安东均 安琳[2] 王治全[3] 张成 马富平 

机构地区：[1]陕西省咸阳市中心医院肝胆外科,陕西咸阳712000 [2]西安财经学院统计学院,陕西西安710100 [3]延安大学医学院第三附属医院肝胆外科,陕西延安716000

出　　处：《中国普通外科杂志》2011年第8期857-860,共4页China Journal of General Surgery

摘　　要：目的探讨采用胆囊切除加Y型胃肠短路联合手术治疗胆囊结石合并2型糖尿病(T2DM)的临床疗效。方法对2008年5月—2010年6月间收治的55例胆囊结石合并T2DM分别采用开腹或腹腔镜胆囊切除联合Roux-en-Y型胃肠短路术,随访1年,分析其临床资料包括手术前后体质指数(BMI),空腹血糖水平(FBG),空腹胰岛素水平(FINS),胰岛素功能指数(HOMA-IR),糖化血红蛋白(HbA1c)的变化及术后1年糖尿病转归情况。结果胆囊结石55例全部治愈。I,II组患者术后BMI较术前无明显变化(P>0.05);全组患者从术后1个月开始空腹血糖水平即出现持续而稳定下降的趋势(P<0.05);伴随着术后血糖水平及胰岛素功能指数的改善,糖化血红蛋白亦出现明显下降(P<0.05)。结论胆囊切除术联合Roux-en-Y型胃肠短路术除可治愈胆囊结石外,对2型糖尿病也具较好的疗效。Objective To explore the clinical efficacy of cholecystectomy plus Roux-en-Y gastric bypass operation on cholecystolithiasis patients with concomitant type 2 diabetes mellitus（T2DM）. Methods Fifty-five cholecystolithiasis patients with concomitant T2DM,who were hospitalized from May 2008 to June 2010,underwent open or laparoscopic cholecystectomy combined with Roux-en-Y gastrojejunal bypass operation.All patients were followed up for one year period and their clinical data that included body mass index（BMI）,fasting blood glucose（FBG）,fasting serum insulin（FINS）,homeostasis model assessment of insulin resistance（HOMA-IR） and glycosylated hemoglobin（HbA1c） before and after surgery as well as outcomes of the diabetes were analyzed. Results All 55 patients were cured of cholecystolithiasis.Of the patients,no significant changes were noted between the BMI values before and after operation（P〈0.05）;at the first month after surgery,the FBG level showed a sustained and steadiely descending trend（P〈0.05）;meanwhile,HbA1c level also decreased significantly（P〈0.05） with the postoperative glucose level and HOMA-IR was remarkably improved. Conclusions The combined procedures of cholecystectomy and Roux-en-Y gastrojejunal bypass operation not only cures cholecystolithiasis,but also has beneficial effects on T2DM.

关 键 词：糖尿病 2型/外科学 胆囊结石/外科学 联合手术 胃肠短路术 腹腔镜手术 

分 类 号：R657.4[医药卫生—外科学]