腹腔镜Roux-en-Y胃旁路术治疗不同体质量指数2型糖尿病的疗效比较  

Comparison of the efficacies of laparoscopic Roux-en-Y gastric bypass surgery in the treatment of patients with different body mass indexes combined with type 2 diabetes mellitus

作　　者：周迪[1] 王勇[1] 耿东华[2] 

机构地区：[1]中国医科大学附属第四医院普通外科,沈阳110004 [2]中国医科大学附属盛京医院普通外科,沈阳110004

出　　处：《中华消化外科杂志》2015年第7期539-544,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81000158）

摘　　要：目的 探讨腹腔镜Roux-en-Y胃旁路术（LRYGB）治疗不同BMI 2型糖尿病的疗效.方法 回顾性分析2013年1-12月中国医科大学附属盛京医院收治的40例2型糖尿病患者的临床资料,8例BMI＜27.5 kg/m2者设为第1组;14例BMI≥27.5 kg/m2且＜ 32.5 kg/m2者设为第2组;18例BMI≥32.5 kg/m2者设为第3组.所有患者行LRYGB,术后随访由中国医科大学附属盛京医院和中国医科大学附属第四医院减重档案管理师根据每例患者手术日期,通过电话指导患者手术相关事项,并进行术后饮食习惯问卷调查,术后1年通知患者返回医院门诊行抽血复查和数据收集.收集患者术前及术后1年的空腹血糖、糖化血红蛋白（HbA1c）、BMI及C肽.同时满足空腹血糖＜7.00 mmol/L和HbA1c ＜7.00％,视为完全缓解,未达到以上标准则视为未缓解.计数资料和率的比较采用x2检验;正态分布的计量资料以-x±s表示,采用t检验;偏态分布的计量资料用中位数（范围）表示,采用Wilcoxon秩和检验;重复测量数据采用重复测量方差分析.结果 40例患者由同一组医师完成LRYGB,围术期无明显并发症发生.40例患者术后随访1年.其中中国医科大学附属盛京医院随访23例,中国医科大学附属第四医院随访8例,其他医院门诊复查随访9例.85.0％ （34/40）的患者术后远期无明显营养不良、吻合口狭窄、离子紊乱、消化道动力障碍等并发症发生,15.0％ （6/40）的患者出现生活习惯极其不适应,频繁恶心、呕吐等梗阻表现.术后1个月内,共有5例患者出现不同程度频繁呕吐、腹痛、夜间烧心等症状,经对症支持治疗后缓解.第2组患者中有1例因术后1周口服高糖饮料出现高渗性昏迷,再次住院治疗后缓解出院.第1组：空腹血糖由术前的11.07 mmol/L（6.00～17.00 mmol/L）下降至7.18 mmol/L（6.00 ～ 15.00 mmol/L）,HbA1c由8.85％（6.00％～11.00％）下降至6.35％（6.00％～9.00％）,BMI由26.0 kg/m2（22.0 ～ 2Objective To investigate the efficacies of laparoscopic Roux-en-Y gastric bypass （LRYGB） surgery in the treatment of patients with different body mass indexes （BMI） and type 2 diabetes mellitus.Methods The clinical data of 40 patients with type 2 diabetes mellitus who underwent LRYGB surgery at the Shengjing Hospital of China Medical University from January 2013 to December 2013 were retrospectively analyzed.According to different BMI,8 patients with BMI 〈 27.5 kg/m2 were allocated into group 1,14 patients with BMI≥27.5 kg/m2 and 〈32.5 kg/m2 in group 2 and 18 patients with BMI≥32.5 kg/m2 in group 3.Forty patients were followed up via telephone interview and food habits questionnaire by weight loss file managers of Shengjing Hospital and the fourth Affiliated Hospital of China Medical University.All the patients received the reexamination of blood test and data collection at postoperative year 1.The preoperative and postoperative 1-year fasting plasma glucose,glycosylated hemoglobin （HbA1 c）,BMI and C-peptide were collected and detected.The fasting plasma glucose 〈 7.00 mmol/L and HbA1 c 〈 7.00% were used as a standard of complete remission.Count data and comparison of rates were analyzed using the chi-square test.Measurement data with normal distribution were presented as x ± s and analyzed by the t test.Skew distribution data were described as M （range） and analyzed by the Wilcoxon rank sum test.Repeated measurement data were analyzed by the repeated measures ANOVA.Results Forty patients received successful LRYGB surgery without perioperative complications,and were followed up for 1 year at the Shengjing Hospital （23 patients）,the fourth Affiliated Hospital （8 patients） and other hospitals （9 patients）.Of the 40 patients,85.0% （34/40） of patients had no postoperative long-term obvious malnutrition,anastomotic stenosis,ion disorders and digestive tract dynamic obstacles,15.0% （6/40） of patients were not adapted to the change of life habits such as frequent nausea a

关 键 词：糖尿病 2型 胃旁路术 空腹血糖 体质量指数 腹腔镜检查 

分 类 号：R587.1[医药卫生—内分泌] R656.61[医药卫生—内科学]