腹腔镜Roux-en-Y胃转流术治疗2型糖尿病近期疗效分析  

Laparoscopic Roux-en-Y gastric bypass for type 2 diabetes: a preliminary report

作　　者：童卫东[1] 高羽[1] 陈静[2] 孙芳[2] 闫振成[2] 倪银星[2] 赵松[1] 刘宝华[1] 祝之明[2] 

机构地区：[1]第三军医大学大坪医院野战外科研究所胃结直肠外科,重庆400042 [2]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病中心重庆市高血压研究所,400042

出　　处：《第三军医大学学报》2013年第9期816-819,共4页Journal of Third Military Medical University

基　　金：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)~~

摘　　要：目的总结分析腹腔镜胃转流术(Roux-en-Y gastric bypass,RYGB)治疗2型糖尿病(type 2 diabetes mellitus,T2DM)的近期疗效,评估手术的安全性。方法回顾性分析我院近2年来腹腔镜RYGB手术治疗的33例T2DM患者临床资料,年龄25～69(47.4±10.5)岁,BMI为22.2～45.5(29.3±4.9)kg/m2,病程1个月至16年,平均4.6年。术后1、3、6、12个月定期随访并检测体质指数(BMI)、腹围、空腹血糖、HbA1c等指标,观察其变化。结果 33例患者均顺利恢复,无死亡,3例并发症(9%)分别为1例吻合口漏,2例吻合口溃疡均保守治愈。随访2～24个月,术后1个月BMI、腹围、空腹血糖、HbA1c等指标即显著降低(P<0.05),在术后6～12个月达到低点。随访满1年的18例患者中,缓解11例(61.1%),血糖控制5例(27.8%),好转2例(11.1%),无效0例。结论腹腔镜RYGB手术对T2DM的近期疗效满意,88.9%的患者达到T2DM缓解或血糖控制,手术安全,值得临床推广。Objective To evaluate the short-term efficiency and safety of laparoscopic Roux-en-Y gas- tric bypass （RYGB） in treatment of type 2 diabetes mel]itus （T2DM）. Methods Thirty-three T2DM patients （ 18 males and 15 females） who underwent laparoscopic RYGB in our department from April 2010 to April 2012 were retrospectively subjected in this study. Data as patient demographics, body mass index （BMI）, abdomeni- nal circumference, and details of diabetes mellitus before and in 1 , 3, 6 and 12 months after operation were collected and analyzed. Results The mean age of the cohort of patients was 47.4 _＋ 10.5 （ range, 25 to 69） , mean BMI was 29.3 __.4.9 （ range, 22.2 to 45.5 kg/m2 ） , and mean duration of T2DM was 4.6 years （ range, 1 month to 16 years）. There was no mortality, but 3 （9%） patients experienced complications, with 1 anasto- motie leakage and 2 marginal ulcer. They all recovered after conventional treatment. During the follow-up peri- od of 2 to 24 months, their BMI, abdomeninal circumference, fasting blood glucose, and HbA1 c were signifi- cantly lower in 1 month after operation than before treatment （P 〈 0.05 ） , and these parameters continued to decline to lowest levels in 6 to 12 months after surgery. Among the 18 patients followed up for over 1 year, 11 （61.1%） patients showed T2DM remission, 5 （27.8%） had well glycemic control, and 2 （ 11.1% ） showed improvement. Conclusion Our study shows RYGB has satisfying effect on T2DM in short term, with 88.9% patients achieving remission or glycemic control. It is safe, and worth of being wildly applied.

关 键 词：糖尿病 胃转流术 病态肥胖 

分 类 号：R587.105[医药卫生—内分泌] R656.9[医药卫生—内科学]