腹腔镜袖状胃切除术治疗肥胖症合并2型糖尿病的疗效及术后便秘的影响因素分析  

Laparoscopic Sleeve Gastrectomy for Obese Patients with Type 2 Diabetes Mellitus and Influencing Factors of Postoperative Constipation

作　　者：王丽晔 于浩泳[1] 朱玮[1] 杜荣慧[1] 吴量[1] WANG Li-ye;YU Hao-yong;ZHU Wei;DU Rong-hui;WU Liang(Department of Endocrine Metabolism,The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University,Shanghai,200233,China)

机构地区：[1]上海交通大学附属第六人民医院内分泌代谢科,上海200233

出　　处：《现代生物医学进展》2022年第13期2458-2462,共5页Progress in Modern Biomedicine

基　　金：上海市第六人民医院院级科学研究基金(院级-2154);上海市浦江人才计划项目(2020PJD044)。

摘　　要：目的:研究腹腔镜袖状胃切除术(LSG)治疗肥胖症合并2型糖尿病患者的临床疗效及术后便秘的影响因素。方法:选取100例LSG治疗的肥胖症合并2型糖尿病患者,随访1年,分析其治疗效果,并记录患者术前、术后3个月、6个月及12个月便秘发生率及便秘严重程度,收集患者资料,对影响便秘发生的因素进行二元logistic回归分析。结果:术后随访1年,患者术后体重、腰围、体质量指数(BMI)、腹内脂肪含量、空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)和甘油三酯水平明显下降(均P<0.05)。术后3个月,排便≤3次/周的患者比例及Wexner评分较术前明显升高(P<0.05)。术后6个月,排便≤3次/周的患者比例较术前增加,但是无统计学差异(P>0.05),Wexner评分低于术前(P<0.05)。术后12个月,排便≤3次/周的患者比例及Wexner评分较术前明显下降(P<0.05)。二元logistic回归分析显示:活动量减少、饮水少及低纤维饮食为术后便秘发生的独立影响因素(P<0.05)。结论:LSG对肥胖症合并2型糖尿病患者有显著减重及降糖疗效,但LSG术后3到个6月时便秘情况有所加重,术后12个月时便秘情况有所改善,便秘的发生是多种因素共同作用的结果。临床医师可通过对患者进行饮食、饮水及运动的指导,以减少便秘的发生。Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrectomy(LSG) in the treatment of obese patients with type 2 diabetes mellitus and the influencing factors of postoperative constipation.Methods:A total of 100 LSG treatment obese patients with type 2 diabetes mellitus were selected,and they were followed up for 1 years.The therapeutic effect was analyzed.The incidence of constipation and the severity of constipation were recorded before operation,3 months,6 months and 12 months after operation.The Data of the patients were collected,Regression analysis was performed on the factors influencing the occurrence of constipation by Binary logistic regression analysis.Results:The patients were followed up for 1 year.The body weight,waist circumference,body mass index(BMI),intra-abdominal fat content,fasting blood glucose,2-hour postprandial blood glucose,glycated hemoglobin A1c(HbA1c) and triglyceride levels in patients after operation decreased significantly(all P0.05),the Wexner score was lower than that before operation(P<0.05).12 months after operation,the proportion of patients with defecation ≤3 times/week and Wexner score decreased significantly compared with those before operation(P<0.05).Binary logistic regression analysis showed that decreased activity,less drinking water and low fiber diet were independent influencing factors of postoperative constipation(P<0.05).Conclusion:LSG has significant weight loss and hypoglycemic effects on obese patients with type 2 diabetes mellitus,but constipation increased from 3 to 6 months after LSG operation.Constipation improved at12 months after operation.The occurrence of constipation is the result of many factors.Clinicians can guide patients through diet,water and exercise to reduce the occurrence of constipation.

关 键 词：腹腔镜袖状胃切除术 肥胖症 2型糖尿病 疗效 便秘 影响因素 

分 类 号：R587.2[医药卫生—内分泌] R589.2[医药卫生—内科学]