腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病27例报告  

Laparoscopic Roux-en-Y Gastric Bypass for Type 2 Diabetes Mellitus:Report of 27 Cases

作　　者：张海涛[1] 梁怀祝[1] 张利[1] 赵国华[1] 张向文[1] 

机构地区：[1]辽宁省大连市中心医院普外二科,大连116033

出　　处：《中国微创外科杂志》2012年第10期898-900,903,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜下Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)治疗2型糖尿病的临床效果。方法 2008年6月～2010年10月行腹腔镜Roux-en-Y胃旁路术27例。沿His角离断胃,保留胃囊20～30 ml,用带有刻度的分离钳保留胆胰支为60～100 cm,食物支为80～150 cm。结果 27例手术成功,无中转开腹。术后1年患者体重指数(body mass index,BMI)26.14±2.01,显著低于术前32.19±3.89(t=11.713,P=0.000);空腹血糖(6.09±1.44)mmol/L,显著低于术前(10.37±2.21)mmol/L(t=12.529,P=0.000);餐后2 h血糖(8.28±1.97)mmol/L,显著低于术前(15.89±1.37)mmol/L(t=16.205,P=0.000);糖化血红蛋白(5.95±1.44)%,显著低于术前(9.48±2.07)%(t=8.900,P=0.000);空腹C肽(1.89±0.27)ng/ml,显著低于术前(2.31±0.40)ng/ml(t=7.927,P=0.000)。1年后2型糖尿病临床治愈率81.5%(22/27),临床有效率14.8%(4/27),临床无效率3.7%(1/27)。结论 LRYGB对肥胖合并2型糖尿病患者是一种安全、有效的治疗方法。Objective To investigate the efficacy of laparoscopic Roux-en-Y gastric bypass （LRYGB） for the treatment of type 2 diabetes mellitus （DM）. Methods Between June 2008 and October 2010, totally 27 patients with type 2 DM underwent LRYGB in our hospital. During the operation, we dissected the stomach from the His angle while a gastric capsule of 20 - 30 ml was kept, and then with calibrated dissecting forceps, a 60- to 100-cm biliopancreatic limb and 80- to 150-cm alimentary limb were reserved. Results The procedure was completed in all the patients without conversion to open surgery. Re-examination at one year after the operation showed that the BMI and levels of fasting plasma glucose, 2-hour postprandial plasma glucose, hemoglobin A1 c, and C-peptide were significantly lower than the preoperative ~alues [ 32.19 ＋ 3.89 vs. 26.14 ＋ 2.01 （ t = 11. 713, P = 0. 000） , （ 10.37 ~ 2.21） mmoL/Lvs. （6.09 ~1.44） mmol/L （t=12.529, P=0.000）, （15.89 ~1.37） mmol/Lvs. （8.28 ~1.97） mmol/L （t= 16.205,P=0.000）, （9.48~2.07）% vs. （5.95 ~1.44）% （t =8.900, P=0.000）, and （2.31 ~0.40） ng/ml vs. （1.89 ~ 0. 27） ng/ml （t =7. 927, P = 0. 000）, respectively]. The rates of clinical cure, effective and ineffective at one year were 81.5% （22/27） , 14.8% （4/27） , and 3.7% （1/27） , respectively. Conclusion LRYGB is safe and effective for type 2 DM.

关 键 词：2型糖尿病 ROUX-EN-Y胃旁路术 腹腔镜 

分 类 号：R656.61[医药卫生—外科学] R587.1[医药卫生—临床医学]