袖状胃切除及胃旁路手术对合并肥胖2型糖尿病近、远期疗效的Meta分析  

Short- and long-term remission of obese type 2 diabetes mellitus after gastric bypass surgery or sleeve gastrectomy: a Meta analysis

作　　者：汤聪[1] 梁文丰[1] 岑宏[1] 陈强[1] 

机构地区：[1]中山大学附属第五医院普外4科微创中心,珠海519000

出　　处：《中华普通外科学文献（电子版）》2014年第4期57-65,共9页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的 探讨袖状胃切除术（SG）及胃转流术（GBP）对2型糖尿病（T2DM）的近、长期疗效的循证支持。方法 检索Cochrane图书馆、Medline及EMbase数据库关于SG及GBP手术治疗合并肥胖的T2DM患者疗效的文献,设立纳入与排除标准筛选文献,进行质量评价、提取数据和数据统计分析。结果 纳入Meta分析标准的文章有34篇,其中8篇为RCT,26项研究涉及GBP,27项研究涉及SG。术前GBP及SG手术患者的基础BMI（kg/m2）分别为44.8±5.2、46.68±7.3;术前指标糖化血红蛋白（%）分别为7.86±0.73、7.91±0.98;空腹血糖水平（mg/dl,1mg/dl=0.055 5 mmol/L）分别为158.0±18.1、167.7±41.6。随访1年GBP和SG术后T2DM缓解率分别为77%、74%,3年缓解率则为74%、85%,5年及以上缓解率分别为77%、74%。8篇RCT文献中行GBP与SG手术治疗T2DM效果的Meta分析,RR=1.26,95%CI=1.10~1.44,GBP术后T2DM缓解率较SG高。结论 GBP及SG手术均是治疗肥胖合并T2DM的有效措施,其近、远期疗效随随访时间无明显下降。GBP治疗T2DM的疗效优于SG手术。Objective To analyze the evidence-based study of short-term and long-term remission of type 2 diabetes mellitus（T2DM） after sleeve gastrectomy（SG） or gastric bypass surgery（GBP）. Methods Related articles were systematically retrieved by searching Medline, Embase database, and Cochrane library. Inclusion and exclusion criteria to select literatures were set up. The data were qualitatively evaluated and analyzed by STATA or SPSS software. Results Thirty-four articles were involved including 8 randomized controlled trials （RCTs）. Among them, 26 studies were on GBP surgeries and 27 on SG. The preoperative BMI of GBP and SG group were （44.8 ± 5.2） kg/m2 and （46.68 ± 7.3） kg/m2, preoperative glycosylated hemoglobin index were （7.86 ± 0.73）% and （7.91 ± 0.98）%, preoperative fasting plasma glucose were （158.0 ± 18.1） mg/dl and （167.7 ± 41.6）mg/dl, retrospectively. After 1 year of follow-up, the remission rate of T2DM was 77% and 74% in GBP and SG groups, while the remission rate was 74% and 85% in followup of 3 years. In follow-up of 5 or more years, the remission rate of SG surgery was 77%, while that of GBP group was 74% according to the Meta analysis. Comparing the remission rate of T2DM in GBP and SG group from the 8 RCTs, the RR was 1.26, 95% CI= 1.10-1.44. The difference between the two groups was statistically significant （P 〈 0.01）. Conclusion Both SG and GBP surgeries are effective treatments for obese T2DM. The remission rate of GBP surgery is higher than SG.

关 键 词：袖状胃切除术 胃转流手术 2型糖尿病 远期疗效 缓解率 

分 类 号：R656.61[医药卫生—外科学]