腹腔镜下胃旁路术治疗2型糖尿病  

The treatment of type 2 diabetes mellitus by laparoscopic gastric bypass surgery

作　　者：戴晓江[1] 张玉新[1] 张红兵[1] 郄文斌[2] 邱小文[3] 唐柚青[4] 金迪[3] 黎飞[1] 曾松华[1] 吴良平[1] 

机构地区：[1]广州军区广州总医院普通外科甲状腺糖尿病外科中心,广州510010 [2]广州军区广州总医院麻醉科,广州510010 [3]广州军区广州总医院营养科,广州510010 [4]广州军区广州总医院ICU,广州510010

出　　处：《中华腔镜外科杂志（电子版）》2014年第3期6-9,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：广东省自然科学基金资助项目(S2011010000472);广东省科技计划项目(2010B060900068)

摘　　要：目的探讨腹腔镜下胃旁路手术治疗2型糖尿病的有效性及可行性。方法参照2011年中国《手术治疗糖尿病专家共识》,选择2型糖尿病患者实施胃旁路手术,并回顾性分析其中随访满12个月的52例患者的糖代谢指标、胰岛细胞功能指标。结果本组2型糖尿病患者术后治疗有效45例(86.5%),完全缓解38例(73.1%),部分缓解7例(13.5%),无效7例(13.5%)。术后空腹血糖、餐后2 h血糖、糖化血红蛋白较术前明显下降(P<0.05);胰岛素与术前比较有统计学差异,但是C肽无统计学意义。虽然术后有一定的手术相关并发症,但总体可控。结论腹腔镜下胃旁路手术是2型糖尿病患者一种有效可行的治疗方法,但需严格把握手术指征;术后胰岛素敏感性的提高发挥重要的治疗作用。Objective To evaluate the efficacy and feasibility of laparoscopic gastric bypass surgery in Chinese patients with type 2 diabetes mellitus （T2DM）. Methods T2DM patients were studied before and after the laparoscopic gastric bypass surgery according to ＆quot;expert consensus of surgical treatment for diabetes＆quot; 2011, China. Glucose metabolism indicators and islet cell function of 52 patients who were over 12 months of follow-up were studied by retrospective analysis. Results There were 45 （86.5%） patients having an improvement in glucose metabolism indicators after surgery. Complete remission, partial remission and non-effect were 38 （73.1%）, 7 （13.5%） and 7 （13.5%）, respectively. Fasting plasma glucose, postprandial 2-hour blood glucose, glycated hemoglobin decreased significantly compared with the preoperative （P〈0.05）; Insulin level was significantly lower than before the operation, with significant difference, but there was no obvious change in the level of C-peptide. Although some procedure-related complications occurred postoperatively, it can be controlled overall. Conclusions Laparoscopic gastric bypass surgery in patients with T2DM is an effective and feasible treatment method, but it needs a strictly thorough evaluation; improvement of postoperative insulin sensitivity plays an important role on outcomes.

关 键 词：胃旁路术 2型糖尿病 血糖 胰岛素 C-肽 

分 类 号：R587.1[医药卫生—内分泌]