两种代谢手术治疗肥胖型2型糖尿病的对比分析  

Comparative analysis of two types of metabolic surgery for obese patients with type 2 diabetes

作　　者：朱信强 单晓东[2] 马济雷 黄海龙 蒋学通 吴建强 孙喜太[2] Zhu Xinqiang;Shan Xiaodong;Ma Jilei;Huang Hailong;Jiang Xuetong;Wu Jianqiang;Sun Xitai(Department of General Surgery,Suqian Hospital,Xuzhou Medical University,Jiangsu 223800,China;Department of General Surgery,Nanjing Drum Tower Hospital,Nanjing University Medical School,Jiangsu 210008,China)

机构地区：[1]徐州医科大学附属宿迁医院普外科,江苏宿迁223800 [2]南京大学医学院附属鼓楼医院普外科,南京210008

出　　处：《中华普外科手术学杂志（电子版）》2020年第5期476-479,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：江苏省第五期“333工程”培养资金资助项目(BRA2019230)。

摘　　要：目的评价两种手术方式对治疗肥胖伴有2型糖尿病(T2DM)的优势。方法回顾分析2012年1月至2019年2月两家医院收治的64例肥胖伴有T2DM的临床资料,根据手术干预情况分为两组,腹腔镜下SG(LSG组)30例和腹腔镜下胃旁路手术(L-RYGB组)34例,采用SPSS 17软件进行统计分析。生化指标等计量资料以(±s)表示,采用独立t检验。术后并发症等计数资料采用χ2检验,采用logistic回归(逐步)模型,分析T2DM缓解与否的危险因素,P<0.05为差异有统计学意义。结果两组患者术后1年血脂相关指标除甘油三酯外,两种手术方法均未获得明显改善。两组间BMI和血糖比较差异无统计学意义(P>0.05);L-RYGB对血糖的缓解率(88.2%)优于LSG(76.7%)P<0.05。而术后1年,两组接受治疗的患者的HbA1c、收缩压和舒张压减少值均明显降低(P=0.016;P=0.029和P=0.017),多因素logistic回归分析,BMI、空腹血糖、HbA1c可作为1年时T2DM缓解的独立危险因素(P=0.001;P=0.001;P=0.008)。L-RYGB显示出T2DM缓解率明显高于LSG(OR=1.79,95%CI:1.133~2.829,P=0.013)。两组患者均未发生30d内死亡和胃肠瘘。在深静脉血栓形成的并发症中,L-RYGB的发生率较高(11.8%vs.3.3%,P=0.022)。结论在T2DM缓解方面,术后1年的结论,L-RYGB优于LSG。远期持久缓解的结果,仍需更长时间的随访研究。Objective To evaluate the advantages of types of metabolic surgery for obese patients with type 2 diabetes(T2DM).Methods From January 2012 to February 2019,the clinical data of 64 cases of obesity with T2DM were retrospectively analyzed.According to the surgical intervention,64 patients were divided into laparoscopic sleeve gastrectomy(LSG)group(n=30)and laparoscopic gastric bypass surgery(L-RYGB)group(n=34).Statistical analysis were performed by using SPSS 17 software.Measurement data such as biochemical indicators were represented as(±s),and were examined by using independent t test.Postoperative complications and other count data were analyzed usingχ2 test and logistic regression(stepwise)model to analyze the risk factors of diabetes remission.A P value of<0.05 was considered as statistically significant difference.Results Except for triglycerides,the blood lipid-related indexes in both two groups were not improved significantly one year after surgery.There were no significant difference in terms of BMI and blood glucose between two groups(P>0.05).In terms of remission rate of blood glucose,there was 88.2%in L-RYGB,which was better than76.7%in LSG group,with significant difference(P<0.05).One year after surgery,there were significant decrease in both groups in terms of HbA1c、systolic blood pressure and diastolic blood pressure(P=0.016;P=0.029 and P=0.017 respectively).Multivariate logistic regression analysis showed that BMI,fasting blood glucose and HbA1c could be used as independent risk factors for diabetes remission at 1 year(P=0.001;P=0.001;P=0.008).There was a higher remission rate in L-RYGB group than that in LSG group,with significant difference(OR=1.79,95%CI:1.133~2.829,P=0.013).There was no death or gastrointestinal fistula within 30 days in either group.There was a higher incidence of deep vein thrombosis in L-RYGB group than that in LSG group(11.8%vs.3.3%,P=0.022).Conclusion In terms of diabetes remission one year after surgery,gastric bypass surgery is superior to sleeve gastrectomy.However,fo

关 键 词：糖尿病 2型 肥胖症 胃旁路术 胃切除术 疗效比较研究 代谢手术 

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