袖状胃切除联合十二指肠-空肠转流术在非肥胖型2型糖尿病中的应用价值  

Application value of the clinical curative effect for laparoscopic sleeve gastrectomy with duodenojejunal bypass to treat non-obese type 2 diabetes

作　　者：殷骏[1] 毛忠琦[1] 徐露[1] 朱政[1] 陈昕[1] 周晓俊[1] 钱海鑫[1] 

机构地区：[1]苏州大学附属第一医院腹腔镜微创外科,苏州215006

出　　处：《中华肥胖与代谢病电子杂志》2015年第1期16-20,共5页Chinese Journal Of Obesity and Metabolic Diseases：Electronic Edition

基　　金：2013苏州市卫生局科教兴卫专项资金(LCZX201303)

摘　　要：目的探讨腹腔镜袖状胃切除联合十二指肠-空肠转流术(laparoscopic sleeve gastrectomyduodenojejunal bypass,LSG-DJB)治疗非肥胖型2型糖尿病的疗效。方法收集苏州大学附属第一医院2012年6月至2013年12月应用LSG-DJB治疗的12例非肥胖型(BMI<30 kg/m2)2型糖尿病患者的临床资料,记录患者的住院时间,手术时间,手术失血量,手术相关并发症,患者术前和术后1、3、6、12个月的体重、BMI、腰围、空腹血糖(FPG)、口服葡萄糖耐量试验、糖化血红蛋白(Hb A1c)、血脂及糖尿病等并发症变化的临床资料,以上临床数据的比较采用t检验。结果所有患者均顺利完成手术,无围手术期死亡患者;1例术后出现烧心感等食道返流症状,经保守治疗后好转;术后患者的FPG、Hb A1c、胰岛素抵抗指数(HOMA-IR)、C肽、体重、BMI、腰围、血清甘油三酯(TG)、低密度脂蛋白(LDL-C)等均较术前显著下降(P<0.05);术后1年,9名患者因2型糖尿病缓解而停药,其中3例彻底治愈(Hb A1c<6.0%),6例得到控制(Hb A1c<7.0%),另外3例降糖药物减量。结论 LSG-DJB可安全施行于非肥胖型2型糖尿病患者,能有效控制体重,改善血糖、血脂水平及相关合并症,近期疗效较好,远期疗效尚有待进一步观察。Objective To explore the clinical effectiveness and safety of laparoscopic sleeve gastrectomy-duodenojejunal bypass （LSG＋DJB） in the non-obese diabetes patients.Methods The data of 12 non-obese patients with type 2 diabetes mellitus who underwent LSG＋DJB from June 2012 to December 2013 were analyzed, including the length of hospitalization, operative time, blood loss, operative related complications and weight, BMI, waist circumference, fasting plasma glucose （FPG）, oral glucose tolerance test, HbA1c, blood lipids and the changing of diabetes complications at pre and postoperative time of 1,3,6 and 12 months.Results All the procedures were preformed smoothly without perioperative death. Esophageal reflux symptoms such as heartburn happened to one case after the procedure, and released after conservative treatment. The FPG, HbA1c, HOMA-IR, C-peptide, weight, BMI, waist circumference, serum triglyceride （TG）, low density lipoprotein cholesterol （LDL-C） of the patients were declined significantly after the procedure （P〈0.05）. One year after the procedures, 9 cases stopped taking medicine because of the remission of T2DM, including 3 cases completely cured （HbA1c〈6.0%） and 6 cases controlled （HbA1c〈7.0%）, andthe other 3 cases decreased hypoglycemic agent.Conclusions LSG＋DJB performed safely in non-obese patients with type 2 diabetes with the good effectiveness of controlling weights, improving blood glucose, blood lipid and related complications. The short-term effectiveness is good, but the long-term effectiveness remains further observation.

关 键 词：腹腔镜下袖状胃切除联合十二指肠-空肠转流术 糖尿病 2型 治疗结果 

分 类 号：R656[医药卫生—外科学] R587.1[医药卫生—临床医学]