以内科为主导多学科协作代谢手术治疗2型糖尿病的临床路径探索  

Exploratory clinical path of surgical treatment for diabetes based on endocrinology-led multidisciplinary cooperation

作　　者：陈静[1] 孙芳[1] 童卫东[2] 何洪波[1] 闫振成[1] 倪银星[1] 赵志刚[1] 刘宝华[2] 杨建江[1] 兰春慧[3] 刘玉娟[4] 毕玉田[5] 高东[6] 程晓斌[5] 祝之明[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所高血压内分泌科,全军高血压代谢中心,重庆市高血压研究所,重庆400042 [2]第三军医大学大坪医院野战外科研究所胃肠外科,重庆400042 [3]第三军医大学大坪医院野战外科研究所消化内科,重庆400042 [4]第三军医大学大坪医院野战外科研究所营养科,重庆400042 [5]第三军医大学大坪医院野战外科研究所医教科技部,重庆400042 [6]第三军医大学大坪医院野战外科研究所神经内科,重庆400042

出　　处：《第三军医大学学报》2013年第9期811-815,共5页Journal of Third Military Medical University

基　　金：国家重点基础研究发展计划(973计划;2012CB517805);重庆市科委国际科技合作基金科技平台与基地建设项目(CSTC2011gjhz10002);第三军医大学校管临床科研课题(2009XLC30;2010XLC38)~~

摘　　要：目的探索多学科合作的手术治疗2型糖尿病的优化临床路径。方法由内分泌科、胃肠外科、消化内科、营养科及心理医生、护理人员和个案管理师组成多学科协作团队;对33例2型糖尿病患者实施胃肠转流手术,术式为胃转流术;按照一定的临床路径实施术前评估、手术治疗、术后管理和长期随访。结果术后1个月主要代谢指标(包括空腹及餐后血糖、糖化血红蛋白、胰岛素抵抗指数、血脂、尿酸)、炎性标志(h-CRP)及肥胖指标(体质量、体质指数、腰围、腹部脂肪分布)与术前相比有显著改善。术后随访1年以上的患者10例,9例获得临床缓解。结论由代谢内分泌科为主导,胃肠外科为骨干,按较优化的临床路径、多学科合作手术治疗糖尿病的模式取得了较好的临床效果。Objective To explore an optimized clinical path for surgical treatment of T2DM based on multidisciplinary cooperation. Methods A multidisciplinary team containing doctors, nurses and case managers from gastrointestinal surgery, endocrinology, gastroenterology, and nutrition division and psychology was estab- lished for this clinical path. A total of 21 patients with identified T2DM undergoing laparoscopic Roux-en-Y gastric bypass （RYGBP） during May 2010 to April 2012 were enrolled in this study. All cases experienced a clinical routine path which included comprehensive medical assessment, laparoscopic RYGBP surgery, posto- perative management and long-term follow-up. Results Major metabolic index （fasting and postprandial blood glucose, glycosylated hemoglobin, insulin resistance index, lipid profile, and uric acid）, hCRP, and obesity parameters （body weight, body mass index, waist circumference, and abdominal fat distribution） were significantly improved in 1 month after operation compared with their preoperative data. Among the 10 patients who were followed up for more than 1 year, 9 gained clinical remission. Conclusion Led by endocrinology and maintained by gastrointestinal surgery, our multidisciplinary cooperation mode of surgical treatment for diabetes establishes an optimal clinical path and achieves good outcomes.

关 键 词：糖尿病 肥胖 代谢手术 内科 临床路径 

分 类 号：R197.32[医药卫生—卫生事业管理] R587.105[医药卫生—公共卫生与预防医学]