3D腹腔镜袖状胃切除术治疗肥胖症合并2型糖尿病的临床疗效及机制  

Clinical effects and mechanism of 3D laparoscopic sleeve gastrectomy in treatment of obesity combined with type 2 diabetes mellitus

作　　者：汪波 王丹雯 习一清 杨丽洁 杨张朔 冯茂辉[1,2] 马丹丹 傅涛 蔡逊 Wang Bo;Wang Danwen;Xi Yiqing;Yang Lijie;Yang Zhangshuo;Feng Maohui;Ma Dandan;Fu Tao;Cai Xun(Department of Gastrointestinal Surgery,Zhongnan Hospital,Wuhan University,Wuhan 430071,China;Department of General Surgery,Central Theater General Hospital of Chinese People's Liberation Army,Wuhan 430070,China)

机构地区：[1]武汉大学中南医院胃肠外科,430071 [2]中国人民解放军中部战区总医院普通外科,武汉430070

出　　处：《中华实验外科杂志》2018年第12期2310-2313,共4页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金面上项目(81770283、81072152);湖北省自然科学基金面上项目(2015CFA027);湖北省卫生计生委科研基金面上项目(WJ2015MA010、WJ2017M249、WJ2017H0048、WJ2017H0043);武汉市腹膜癌临床医学研究中心项目(2015060911020462)。

摘　　要：目的探讨3D腹腔镜袖状胃切除术(LSG)治疗肥胖症合并2型糖尿病(T2DM)的安全性、可行性、临床疗效及对胰高血糖素样肽1(GLP-1)和胃饥饿素(Ghrelin)水平的影响。方法我院收治的26例肥胖症合并T2DM患者均由同一手术团队施行3D腹腔镜袖状胃切除术。术后随访1年,观察术后恢复情况、减重降糖效果及Ghrelin和GLP-1的变化。结果26例患者均顺利完成手术,无中转开腹,术后均无吻合口漏、出血及狭窄等严重并发症发生和围手术期死亡。手术时间为(60.00±17.06)min,术中出血量为(7.31±2.54)ml,下床活动时间为(1.58±0.50)d,术后胃肠功能恢复时间为(1.92±0.63)d,术后住院时间为(7.50±1.21)d,术后第1天数字分级法(NRS)评分为(3.42±0.50)分,术后第3天NRS评分为(1.42±0.50)分。26例患者均获得术后随访。与术前比较,所有患者术后3、6、12个月体重、体重指数(BMI)、腰围、臀围、腰臀比均显著降低(体重:P=0.001、0.000、0.000;BMI:P=0.001、0.000、0.000;腰围:P=0.000、0.000、0.000;臀围:P=0.017、0.000、0.000;腰臀比:P=0.017、0.000、0.000),减重效果显著。与术前比较,所有患者术后3、6、12个月空腹血糖、空腹胰岛素、空腹C肽、糖化血红蛋白均明显降低(空腹血糖:P=0.000、0.000、0.000;空腹胰岛素:P=0.000、0.000、0.000;空腹C肽:P=0.002、0.000、0.000;糖化血红蛋白:P=0.000、0.000、0.000),降糖效果显著。26例患者术后12个月T2DM缓解率92.31%(24/26),有效率为100.0%(26/26)。所有患者术后3、6、12个月血Ghrelin水平较术前明显降低(0.000、0.000、0.000),GLP-1未见显著变化(P=0.797、0.300、0.597)。结论LSG治疗肥胖症合并T2DM安全可行,近期临床效果显著。LSG主要通过改变Ghrelin的含量来调控血糖。Objective To investigate the feasibility, safety and clinical effects of 3D laparoscopic sleeve gastrectomy (LSG) in treatment of obesity combined with type 2 diabetes mellitus (T2DM) and its impact on blood Ghrelin levels. Methods Clinical data of 26 patients who underwent 3D laparoscopic sleeve gastrectomy in our hospital between January 2016 and September 2017 were retrospectively collected. All the 26 patients were operated by the same surgical team. The patients were followed up for 1 year. The surgical and postoperative recovery situations, the effect of weight reduction, hypoglycemic effects, serum Ghrelin levels and glucagon like peptide 1 (GLP-1) were observed at 3rd, 6th and 12th month after operation. Results The 3D LSG was performed successfully on 26 patients, without conversion to open surgery. There were no postoperative complications (anastomotic leak, bleeding and stenosis, etc) and perioperative death. Operation time, volume of intraoperative blood loss, time of out of bed, time of postoperative gastrointestinal function recovery and hospital stay were (60.00±17.06) min, (7.31±2.54) ml, (1.58±0.50) days, (1.92±0.63) days, and (7.50±1.21) days, respectively. The numerical rating scale score was (3.42±0.50) and (1.42±0.50) respectively at 1st and 3rd day after operation. All 26 patients were followed up. As compared to pre-operation, the average body weight, BMI, waist circumference, hip circumference and waist-hip Ratio were all decreased at 3rd, 6th and 12th month after operation (body weight: P=0.001, 0.000, 0.000; BMI: P=0.001, 0.000, 0.000; waist circumference: P=0.000, 0.000, 0.000; hip circumference: P=0.017, 0.000, 0.000; WHR: P=0.017, 0.000, 0.000). Meanwhile, as compared to pre-operation, the average fasting blood glucose (FBG), the fasting serum inculin (FINS), the fasting C-peptide (FCP) and the HbA1c were all reduced at 3rd, 6th and 12th month after operation (FBG: P=0.000, 0.000, 0.000; FINS: P=0.000, 0.000, 0.000; FCP: P=0.002, 0.000, 0.000; HbA1c: P=0.000, 0.000, 0.000). The

关 键 词：3D腹腔镜 2型糖尿病 袖状胃切除术 临床疗效 胃饥饿素 

分 类 号：R656.61[医药卫生—外科学]