不同吻合方式对腹腔镜胃肠旁路术治疗2型糖尿病的疗效  

Larporoscopic Roux-en-Y gastric bypass by different anastomoses for the treatment of type 2 diabetes mellitus

作　　者：廉东波[1] 朱斌[1] 宫轲[1] 阿民布和[1] 李凯[1] 王桐生[1] 张东东[1] 张能维[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院糖尿病外科治疗中心,100038

出　　处：《中华普通外科杂志》2012年第9期713-716,共4页Chinese Journal of General Surgery

基　　金：北京市科技委员会首都临床特色应用研究基金资助（Z111107058811052）

摘　　要：目的探讨不同吻合方式在腹腔镜胃肠旁路术治疗2型糖尿病中的临床疗效。方法将21例2型糖尿病患者根据不同的胃空肠吻合方式分为经口吻合器组（9例）和腹腔镜直线切割闭合器（Endo—GIA）组（12例），分析手术完成情况、并发症情况以及糖尿病治疗效果。结果本组21例均成功完成手术，无中转开腹，无明显并发症。两组的术中出血量、术后恢复时间之间相比差异无统计学意义（P〉0．05），经口吻合器组手术时间为（126±29）min，明显短于Endo-GIA组（156±28）min（P〈0．05），但经口吻合器组费用较高。经VI吻合器组9例患者中，7例治愈，术后停用降糖药物，2例有效；Endo—GIA组12例患者中，10例治愈，2例有效。21例患者总治愈率为81％，总有效率为100％。两组的营养指标无明显改变。结论不同吻合方式对于2型糖尿病手术治疗效果相同。Objective To evaluate treatment of type 2 diabetes mellitus （T2DM） by laparoscopic Roux-en-Y gastric bypass （LRYGB） using different amastomoses. Methods Twenty one T2DM patients were divided into two groups ： transoral EEA （OrVil） and Endo-GIA according to ways of gastrointestinal anatomosis and underwent LRYGB. Clinical data including outcome of operation, complications, preoperative and postoperative oral glucose tolerance test （OGTY）, Homa-IR, Homa-[3, blood lipid and nutrition status were analyzed. Results LRYGB procedures were successfully performed in all the 21 patients with no conversion to open surgery. The difference of intraoperative blood loss, postoperative recovery time between two groups was not significant. The mean operation time in OrVil group （126 ± 29） mins was shorter than that in Endo-GIA group （ 156 ±28） rains （P 〈0.05）, but at the same time, the mean expenditure was higher. Evaluated on three months after operation, the T2DM cure rate was 78%, and effective rate was 100% in OrVil goup and those were 83%, 100% respectively in Endo-GIA group. No postoperative malnutrition, anemia or severe complication occurred. Conclusions The efficiency of laparoscopic Roux-en-Y gastric bypass using different amastomoses was same in the treatment of type 2 diabetes mellitus. The operation time was shorter in OrVil group but the expenditure was higher.

关 键 词：糖尿病 2型 腹腔镜 吻合术 Roux—en—Y 

分 类 号：R587.1[医药卫生—内分泌]