腹腔镜下胃旁路术对体质指数＜28 kg/m2的2型糖尿病患者的效果研究  

Effects of laparoscopic gastric bypass surgery in patients with type 2 diabetes and body mass index 〈28 kg/m2

作　　者：郭妍[1] 李慧华[1] 刘超乾[2] 邹大进[1] 

机构地区：[1]第二军医大学附属长海医院内分泌科,上海200433 [2]第二军医大学附属长海医院普外科,上海200433

出　　处：《中华糖尿病杂志》2014年第4期245-248,共4页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金项目（81170738、81300684）

摘　　要：目的 探讨腹腔镜下胃旁路术对体质指数（BMI） ＜28 kg/m2的2型糖尿病（T2DM）患者的安全性及有效性.方法 回顾性分析2008年1月至2012年12月在第二军医大学附属长海医院接受胃旁路手术治疗的27例血糖控制不佳的非肥胖T2DM患者的术前资料,对其进行电话和（或）门诊随访,了解术后患者BMI、腰围、血糖、血压、血脂、术后并发症、饮食习惯及手术满意度等.两组之间比较采用t检验.结果 成功随访21例（77.8％）,平均随访时间（2.7±1.1）年,无l例死亡,2例术后出现吻合口溃疡.术后空腹血糖（FPG）及糖化血红蛋白（HbAlc）较术前明显改善[FPG：（6.4±1.5）比（8.2±3.2）mmol/L,t=2.787,P＜0.05;HbAlc：（6.6±1.2）％比（7.8±1.9）％,t=2.473,P＜0.05].手术前后体重及BMI差异有统计学意义[分别为（65±12）比（77±10） kg,t=4.474,P＜0.05;（22.8±4.6）比（25.1±2.3）kg/m2,t2.756,P＜0.05],术后腰围较术前减小,差异有统计学意义[（83±8）比（93±12）cm,t =3.133,P＜0.05].术后13例（61.9％）患者糖尿病缓解,5例（23.8％）疗效改善,无效者3例（14.3％）.糖尿病缓解者与未缓解者相比,术前各项指标无统计学差异（均P ＞0.05）.此外,胃旁路术后高血压缓解率为54.5％ （6/11）,血脂异常缓解率为66.7％ （10/15）,所有患者对手术平均满意度为（83±17）％.结论 腹腔镜下胃旁路术对于BMI＜28 kg/m2的T2DM患者是较为安全和有效的,在减轻体重及改善血糖的同时还具有控制血压和调节血脂的作用.Objective To explore the effect and safety of laparoscopic gastric bypass surgery in patients with type 2 diabetes mellitus and body mass index （BMI） ＜ 28 kg/m2.Methods Twenty-seven consecutively selected diabetic patients with BMI ＜ 28 kg/m2 underwent gastric bypass in a tertiary-care hospital from January,2008 to December,2012 were retrospectively studied and followed up with telephone interview.Postoperative changes in BMI,waist circumference,glycaemic control,lipid levels,blood pressure,surgery related complications,diet habits and degree of satisfaction were recorded.Result Totally 21 patients （77.8％） were successfully followed.Mean follow-up time was （2.7 ± 1.1） years.There was no mortality,but 2 anastomotic ulcer,postoperatively.The fasting plasma glucose （FPG） and glycated hemoglobin Alc （HbAlc） decreased significantly after surgery （FPG：（6.4 ± 1.5） vs （8.2 ± 3.2） mmol/L,t =2.787 ; HbA1 c：（6.6 ± 1.2） ％ vs （7.8 ± 1.9） ％,t =2.473,both P ＜ 0.05）.And there were statistical difference in weight and BMI before and after operation （weight（77 ± 10）vs（65 ± 12） kg,t =4.474,BMI（25.1 ±2.3）vs（22.8 ±4.6） kg/m2,t =2.756,both P ＜0.05）.So was the change of waist circumference （（93.3 ± 11.7） vs （83.3 ±7.6） cm,t =3.133,P ＜0.05）.Diabetes remission occurred in 61.9％ of cases （13/21）,with glycemic improvement in 23.8％ （5/21）,and failure in 14.3％ （3/21）.Compared with the patients with diabetes improved and failed,the preoperative characteristics of diabetes remission group had no significant difference.Rate of hypertension and dyslipidemia remission were 54.5％ and 66.7％,respectively.And the average satisfaction for all patients was （83 ± 17）％.Conclusion Gastric bypass surgery somehow safely and effectively ameliorated diabetes and associated comorbidities,in patients with a BMI of ＜ 28 kg/m2,independent with weight loss.But the validity still need more research to confirm.

关 键 词：糖尿病 2型 胃旁路术 临床研究 

分 类 号：R587.1[医药卫生—内分泌]