腹腔镜胃旁路手术治疗2型糖尿病的临床疗效和安全性  

Clinical Effectiveness and Safety of LRYGB in Surgical Treatment of T2DM

作　　者：朱政[1] 殷骏[1] 吴润达[1] 毛忠琦[1] ZHU Zheng;YIN Jun;WU Run-da;MAO Zhong-qi(Department of Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China)

机构地区：[1]苏州大学附属第一医院普通外科,江苏苏州215006

出　　处：《中国血液流变学杂志》2017年第2期191-196,共6页Chinese Journal of Hemorheology

基　　金：苏州市“科教兴卫”青年科技项目（KJXW2013008）,苏州市临床重点病种诊疗技术专项项目（LCZX201303）,江苏省临床医学科技专项项目-新型临床诊疗技术攻关资助项目（BL2014048）

摘　　要：目的 探讨腹腔镜下Roux-en-Y胃旁路术（laparoscopic Roux-en-Y gastric bypass,LRYGB）治疗2型糖尿病病人的临床有效性及安全性.方法 收集2010年5月—2012年2月临床病例共73例,均采用腹腔镜下胃旁路手术进行糖尿病治疗,其中有36例2型糖尿病患者已经完成了5年的随访调查.将患者分为高BMI组（BMI〉27.5 kg/m2）和低BMI组（BMI≤27.5 kg/m2）.详细记录内容包括患者的手术时间、住院时间、失血量、术后并发症等,还包括患者手术前后1、2、3、5年的各项指标,包括患者的体重、腰围、BMI、FPG、2hPG、HbA1c、C肽（CP）及血清胰岛素等.结果 所有73例进行腹腔镜下胃旁路手术治疗的患者均顺利出院,围手术期内无死亡病例,术后30 d内,手术相关并发症的比例为11.0%（8/73）.手术后患者的FPG、HbA1c、BMI、血清甘油三酯、胆固醇等较术前均有显著下降（P〈0.05）.腹腔镜下胃旁路手术治疗2型糖尿病术后5年,低BMI组与高BMI组2型糖尿病的控制率分别为40.0%（6/15）,76.2%（16/21）,其差异有统计学意义（P〈0.05）.将2型糖尿病得到控制与得到改善病人的术前指标相比较,其中BMI、腰围、糖尿病病程、2hPG和2hCp差异有统计学意义（P〈0.05）.结论 伴有或者不伴有肥胖的2型糖尿病患者,均可安全施行腹腔镜下胃旁路手术,且很少产生不良并发症;与非肥胖患者的手术疗效相比,肥胖患者的手术疗效更明显.患者术前的BMI、腰围、糖尿病病程、2hPG和2hCp可作为预测手术治疗预后的指标.Objective To discuss the clinical effectiveness and safety of laparoscopic Rouex-en-Y gastric bypass （LRYGB） in surgical treatment of type 2 diabetes mellitus （T2DM）. Methods The data of 73 patients with T2DM who underwent LRYGB in the First Affiliated Hospital of Soochow University from May 2010 to February 2012 were retrospectively analyzed. Among them, 36 patients had finished a 5-year period of follow-up survey. The patients were divided into 2 groups, the high-BMI （body mass index） group （BMI〉27.5 kg/m2） and the low-BMI group （BMI≤27.5 kg/m2）. Clinical data of patients, such as the length of hospital stay, operative time, blood loss, surgical operation related complications were recorded. All patients were subjected to follow-up controls with anthropometric and metabolic indices, such as weight, BMI, waist circumference, fasting plasma glucose （FPG） and oral glucose tolerance test （OGTT）, HbA1c, C peptide, serum insulin, blood lipids and the change of diabetes complications, etc, at 0.5, 1, 2, 3 and 5 years after surgery. Results All patients were discharged smoothly after surgery without perioperative death and surgery related complications were 11.0% （8/73）. The FPG, HbA1c,weight, BMI, waist circumference, serum triglyceride and cholesterol of the patients were declined significantly （P〈0.05） and rapidly after the operation. 76.2% （16/21） of the high-BMI group patients and 40.0% （6/15） of the low-BMI group patients with T2DM got remission after the surgery 5 years later. The difference between the remission rate of the two groups was statistically significant （P〈0.05）. Pre- operatively, the differences of BMI, waist circumference, course of T2DM, 2 hours postprandial plasma glucose （2hPG） and 2 hours postprandial blood C peptide （2hCp） between the remission group and the improvement group were statistically significant （P〈0.05）. Conclusion LRYGB can be performed safely on obese or non-obese patients with T2DM without severe complications

关 键 词：腹腔镜 胃旁路手术 2型糖尿病 疗效 

分 类 号：R587.1[医药卫生—内分泌] R656.6[医药卫生—内科学]