腹腔镜袖状胃切除术治疗病态性肥胖症合并2型糖尿病的疗效及相关因素分析  

The efficacy and related factors analysis of laparoscopic sleeve gastrectomy in the treatment of morbid obesity combined with type 2 diabetes mellitus

作　　者：王孝珑 祝林[1] 葛宏[2] 吴建林[1] 杨晓平 刘志民[1] WANG Xiao-long;ZHU Lin;GE Hong(Department of Anorectal Surgery,Zibo Central Hospital,Zibo 255036,China;Department of Respiratory Medicine of West Hospital,Zibo Central Hospital)

机构地区：[1]淄博市中心医院肛肠外科,山东淄博255036 [2]淄博市中心医院西院区呼吸内科

出　　处：《腹腔镜外科杂志》2021年第3期165-171,共7页Journal of Laparoscopic Surgery

基　　金：山东省医药卫生科技发展计划项目(2018WSA03043);淄博市科技发展重点研发项目(2018kj010092)。

摘　　要：目的:探讨腹腔镜袖状胃切除术(LSG)治疗病态性肥胖症合并2型糖尿病的临床疗效,并分析影响疗效的相关因素。方法:回顾分析2013年7月至2018年7月为45例病态性肥胖症合并2型糖尿病患者行LSG的临床资料及随访情况,分析手术对患者体重及血糖的控制情况,并应用单因素与多因素Logistic回归分析影响体重及血糖控制效果的相关因素。结果:45例手术均顺利完成,术后随访1年,患者体重、空腹血糖呈下降趋势,34例减肥效果佳或良好(额外体重减轻百分率≥50%),28例2型糖尿病治疗明显有效,有效率为62.2%。单因素Logistic回归分析显示,BMI、遵循术后指导及术后胃饥饿素水平影响LSG治疗病态性肥胖症的疗效(P<0.05);额外体重减轻百分率、吸烟、空腹胰岛素、胰岛素抵抗指数、术后胆汁酸水平影响LSG对2型糖尿病的疗效(P<0.05)。多因素回归分析显示,BMI、是否遵循术后指导及术后胃饥饿素水平是LSG对病态性肥胖疗效的独立影响因素(P<0.05);额外体重减轻百分率、吸烟及胰岛素抵抗指数是LSG对2型糖尿病疗效的独立影响因素(P<0.05)。结论:LSG不仅治疗病态性肥胖症疗效确切,对于合并的2型糖尿病也有明显缓解作用,值得推广应用。Objective:To investigate the efficacy of laparoscopic sleeve gastrectomy(LSG)in the treatment of morbid obesity with type 2 diabetes mellitus and analyze the related factors of the efficacy.Methods:The clinical data and the follow-up of 45 patients with morbid obesity complicated with type 2 diabetes mellitus who underwent LSG were retrospectively analyzed from Jul.2013 to Jul.2018.The body weight and blood glucose control after operation were analyzed,and the related factors affecting the weight and blood glucose control were analyzed by univariate and multivariate logistic analysis.Results:All patients underwent the operation and were followed up for 1 year,the body weight and fasting blood glucose of the patients decreased.34 patients had effective weight loss,percentage of excess weight loss(%EWL)was≥50%.28 patients significantly improved blood glucose,and the effective rate was 62.2%.Univariate logistic regression analysis showed that BMI,following postoperative guidance and postoperative ghrelin levels significantly affected the efficacy of LSG on morbid obesity(P<0.05).%EWL,smoking,fasting insulin,homeostasis model assessment of insulin resistance and postoperative bile acid levels affected the efficacy of LSG on type 2 diabetes mellitus(P<0.05).Multivariate regression analysis showed that BMI,following postoperative guidance and postoperative ghrelin were independent influencing factors of the efficacy of LSG on morbid obesity(P<0.05).%EWL,smoking and homeostasis model assessment of insulin resistance were independent influencing factors of the efficacy of LSG on type 2 diabetes mellitus(P<0.05).Conclusions:LSG can not only effectively treat morbid obesity,but also significantly alleviate type 2 diabetes mellitus,it is worthy of popularization.

关 键 词：肥胖症 糖尿病 2型 袖状胃切除术 腹腔镜检查 

分 类 号：R656.61[医药卫生—外科学]