腹腔镜代谢手术在肥胖合并2型糖尿病治疗中的疗效和安全性分析  

Efficacy and safety analysis of laparoscopic metabolic surgery in the treatment of obesity with type 2 diabetes mellitus

作　　者：李超杰[1] 赵象文[2] 濮先明[1] 梁銮盛 杨慧英[2] LI Chao-jie;ZHAO Xiang-wen;PU Xian-ming(Department of Endocrinology and Metabolism,Zhongshan Xiaolan People's Hospital,Zhongshan 528415,China)

机构地区：[1]中山市小榄人民医院内分泌代谢科,528415 [2]中山市小榄人民医院减重与代谢病外科,528415

出　　处：《中国现代药物应用》2022年第10期42-45,共4页Chinese Journal of Modern Drug Application

基　　金：中山市医学科研项目(项目编号:2020A020405)。

摘　　要：目的 分析腹腔镜代谢手术在肥胖合并2型糖尿病治疗中的应用效果。方法 60例肥胖合并2型糖尿病患者,根据手术方式不同分为腹腔镜组(28例)与对照组(32例)。腹腔镜组实施腹腔镜袖状胃切除术治疗,对照组实施腹腔镜Roux-en-Y胃旁路术治疗。比较两组临床疗效、手术指标、手术前后的糖脂代谢情况、手术前后的体质量指数(BMI)及额外体重减轻百分比、并发症发生情况。结果 腹腔镜组治疗总有效率为96.43%,高于对照组的78.13%,差异有统计学意义(P<0.05)。腹腔镜组术中出血量少于对照组,术后住院时间与术后排气时间短于对照组,差异均有统计学意义(P<0.05)。两组术后3个月的空腹血糖、餐后2 h血糖、空腹C肽、糖化血红蛋白(HbA1c)、总胆固醇与甘油三酯均较术前下降,差异有统计学意义(P<0.05);两组术前及术后3个月的空腹血糖、餐后2 h血糖、空腹C肽、HbA1c、总胆固醇与甘油三酯组间比较差异无统计学意义(P>0.05)。术后3个月,两组BMI均低于术前,且腹腔镜组低于对照组,差异有统计学意义(P<0.05);术后3个月,腹腔镜组额外体重减轻百分比为(52.00±19.00)%,高于对照组的(40.00±15.00)%,差异有统计学意义(P<0.05)。腹腔镜组并发症发生率为7.14%,低于对照组的31.25%,差异有统计学意义(P<0.05)。结论 腹腔镜袖状胃切除术用于肥胖合并2型糖尿病患者中,可缩短手术操作时间,稳定患者血脂水平,保证患者手术安全性,应用价值显著。Objective To analyze the application effect of laparoscopic metabolic surgery in the treatment of obesity with type 2 diabetes mellitus.Methods A total of 60 patients with obesity and type 2 diabetes mellitus were divided into laparoscopic group (28 cases) and control group (32 cases) according to different surgical methods.The laparoscopic group was treated with laparoscopic sleeve gastrectomy,and the control group was treated with laparoscopic Roux-en-Y gastric bypass.Both groups were compare in terms of clinical efficacy,surgical indicators,glycolipid metabolism before and after surgery,body mass index (BMI) before and after surgery,the percentage of excess weight loss,and complications.Results The total effective rate of the laparoscopy group was 96.43%,which was higher than 78.13%of the control group,and the difference was statistically significant(P<0.05).The intraoperative blood loss in the laparoscopic group was less than that in the control group,and the postoperative hospitalization time and postoperative exhaust time were shorter than those in the control group.All the differences were statistically significant (P<0.05).The fasting blood glucose,2 h postprandial blood glucose,fasting C-peptide,glycosylated hemoglobin (HbA1c),total cholesterol and triglyceride in the two groups at 3 months after surgery were all lower than those before surgery,and the difference was statistically significant(P<0.05).There was no statistically significant difference in fasting blood glucose,2 h postprandial blood glucose,fasting C-peptide,HbA1c,total cholesterol and triglyceride between the two groups before surgery and at 3 months after surgery (P>0.05).At 3 months after surgery,the BMI of both groups was lower than that before surgery,and the laparoscopic group was lower than the control group.All the differences were statistically significant (P<0.05).At 3 months after surgery,the percentage of excess weight loss in the laparoscopic group was (52.00±19.00)%,which was higher than (40.00±15.00)%in the control group,an

关 键 词：腹腔镜代谢手术 肥胖 2型糖尿病 安全性 

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