胃旁路术对2型糖尿病患者的长期疗效分析  

Analysis of the long-term efficacy of gastric bypass surgery on patients with type 2 diabetes mellitus

作　　者：闫文貌[1] 李有国[1] 许峻[1] 钟志强[1] 邢颖[1] 闫鸣[1] 白日星 Yan Wenmao;Li Youguo;Xu Jun;Zhong Zhiqiang;Xing Ying;Yan Ming;Bai Rixing(Department of General Surgery,Bejing Tiantan Hospital,Capital Medical University,Bejing 100070,China;Department of General Surgery,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京天坛医院普外科,北京100070 [2]首都医科大学附属北京潞河医院普外科,北京101149

出　　处：《中华腔镜外科杂志（电子版）》2023年第3期152-157,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：首都卫生发展科研专项重点项目(2020-1-2021)。

摘　　要：目的:探讨胃旁路术(Roux-en-Y gastric bypass,RYGB)对2型糖尿病(Type 2 diabetes mellitus,T2DM)患者的长期疗效及安全性。方法:检索首都医科大学附属北京天坛医院接受RYGB治疗的T2DM患者,选取术后随访满5年、数据完善的病例,分析术前、术后患者的体重、血糖、合并疾病、营养等指标的变化以及手术远期并发症发生情况。结果:37例行RYGB的T2DM患者入组。平均随访6.2(5.0~9.0)年。术后5年,体重、糖化血红蛋白(HbA1c)均较术前明显减低,差异均有统计学意义(P均<0.05)。术后5年仅有29.7%的患者使用降糖药物,较术前的糖尿病用药情况明显减低,差异有统计学意义(P<0.01)。术后5年T2DM的完全缓解率为29.7%。与术前相比,术后5年甘油三酯(triglyceride,TG)明显减低,高密度脂蛋白(high density lipoprotein,HDL)明显升高,脂代谢异常以及肝功能异常人数明显减少,差异均有统计学意义(P均<0.05)。在营养方面,术后5年铁蛋白水平较术前明显减低,差异有统计学意义(P<0.05)。血红蛋白、白蛋白、叶酸、维生素B12均较术前减低,但差异无统计学意义(P均>0.05)。术后5年1例(3.0%)伴有反复不全肠梗阻症状,2例(6.0%)新发胆囊结石,6例(18.2%)出现缺铁性贫血。结论:RYGB对于T2DM患者远期仍是安全、有效的。RYGB术后存在体重、血糖反弹、营养障碍等风险。术后应重视患者的随访、饮食及用药指导,RYGB术后患者要预防性补充铁剂、维生素及各种微量元素。Objective:To investigate the long-term efficacy and safety of gastric bypass(Roux-en-Y gastric bypass,RYGB)on patients with type 2 diabetes mellitus(T2DM).Methods:T2DM patients who received RYGB in Beijing Tiantan Hospital Affiliated to Capital Medical University were retrieved from Bariatric and Metabolic Surgery Database.Cases with complete data after 5 years of postoperative follow-up were selected to analyze the preoperative and postoperative weight,blood glucose,and combined changes in indicators such as disease and nutrition,as well as the occurrence of long-term complications of surgery.Results:Thirty-seven patients with T2DM undergoing RYGB were enrolled.The mean follow-up was 6.2(5.0-9.0)years.Five years after operation,body weight and glycosylated hemoglobin(HbA1c)of all were significantly lower than those before operation,and the differences were statistically significant(all P values were less than 0.05).Only 29.7%of the patients used hypoglycemic drugs 5 years after operation,which was significantly lower than that before operation,and the difference was statistically significant(P<0.01).The complete remission rate of T2DM after 5 years was 29.7%.Compared with before operation,triglyceride(TG)was significantly reduced,high-density lipoprotein(HDL)was significantly increased,and the number of abnormal lipid metabolism and abnormal liver function were significantly reduced at 5 years after operation,and the differences were statistically significant(P value are less than 0.05).In terms of nutrition,the level of ferritin at 5 years after operation was significantly lower than that before operation,and the difference was statistically significant(P<0.05).Hemoglobin,albumin,folic acid,and vitamin B12 were all lower than those before operation,but the differences was not statistically significant(all P values were greater than 0.05).Five years after operation,1 case(3.0%)was accompanied by symptoms of recurrent incomplete intestinal obstruction,2 cases(6.0%)developed new gallbladder stones,and 6 cases(18.2

关 键 词：腹腔镜 胃旁路术 糖尿病 2型 减重手术 长期疗效 

分 类 号：R656.61[医药卫生—外科学] R587.1[医药卫生—临床医学]