腹腔镜胃袖状切除术治疗肥胖合并2型糖尿病及脂肪胰的临床研究  

Clinical study of laparoscopic gastric sleeve resection in the treatment of obesity complicated with type 2 diabetes mellitus and fatty pancreas

作　　者：李猛[1] 姜腊 董磊[1] 吴情 贾犇黎[3] Li Meng;Jiang La;Dong Lei;Wu Qing;Jia Ben Li(Department of gastrointestinal Surgery,Anhui Wanbei Coal-Electricity Group General Hospital,Suzhou Anhui Province 234000,China;General Clinical Research Center,Anhui Wanbei Coal-Electricity Group General Hospital,Suzhou Anhui Province 234000,China;Department of gastrointestinal Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefei Anhui Province 230601,China)

机构地区：[1]皖北煤电集团总医院胃肠外科,安徽宿州234000 [2]皖北煤电集团总医院中心实验室,安徽宿州234000 [3]安徽医科大学第二附属医院胃肠外科,合肥230601

出　　处：《中华普外科手术学杂志（电子版）》2024年第5期554-557,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2020年度宿州市科技计划项目(SZSKJZC2020033)。

摘　　要：目的:探究腹腔镜胃袖状切除术(LSG)治疗肥胖合并2型糖尿病及脂肪胰的临床效果。方法:回顾性分析2021年1月至2022年10月行LSG治疗的63例肥胖合并2型糖尿病及脂肪胰患者临床资料,分析手术前后减重效果、代谢指标及胰腺功能指标变化情况,统计术后12个月患者2型糖尿病、脂肪胰及其他合并症缓解情况。采用SPSS 25.0分析数据。物理指标、血糖和血脂代谢指标等计量资料以(x±s)表示,采用配对样本t检验;合并症情况等计数资料以[例(%)]表示。P<0.05为差异有统计学意义。结果:与术前比较,术后6个月、12个月患者体重、体重指数(BMI)、多余体重减轻百分比(EWL%)、腰围、臀围、收缩压、舒张压等物理指标及空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)等血糖、血脂代谢指标呈下降趋势,且术后12个月各指标水平显著低于术后6个月(P<0.05);与术前比较,术后6个月、12个月患者胰岛素抵抗指数(Homa-IR)明显降低,胰岛β细胞功能(Homa-β)水平明显升高,且术后12个月Homa-IR显著低于术后6个月,术后12个月Homa-β水平明显高于术后6月(P<0.05)。至术后12个月,2型糖尿病的缓解率为71.4%,合并症脂肪胰、高血压、高血脂症缓解率分别达到了82.5%、77.8%、81.8%。结论:LSG治疗肥胖合并2型糖尿病及脂肪胰安全有效,可达到明显的减重效果,同时可改善血糖、血脂等代谢情况及胰腺功能,且术后多数患者可达到糖尿病缓解和脂肪胰缓解。Objective:To explore the clinical effect of laparoscopic sleeve gastrectomy(LSG)in the treatment of obesity complicated with type 2 diabetes mellitus and fatty pancreas.Methods:Clinical data of 63 obese patients with type 2 diabetes mellitus and adipopancreatitis treated with LSG from January 2021 to Qctober 2022 were retrospectively analyzed,and the weight loss effect,metabolic indexes and pancreatic function indexes before and after surgery were analyzed,and the remission of type 2 diabetes mellitus,adipopancreatitis and other complications were statistically analyzed 12 months after surgery.SPSS 25.0 was used to analyze the data.The measurement data of physical indexes,blood glucose and lipid metabolism indexes were expressed as(x±s),and paired sample t-test was used.Statistical data such as comorbidities are presented as[cases(%)].P<0.05 was considered statistically significant.Results:Compared with pre-operation,At 6 and 12 months after surgery,the patient's body weight,body mass index(BMI),percentage of excess weight loss(EWL%),waist circumference,hip circumference,systolic blood pressure,diastolic blood pressure and other physical indexes,fasting blood glucose(FPG),glycated hemoglobin(HbA1c),fasting insulin(FINS),total cholesterol(TC),triglyceride(TG),and low density lipoprotein(LDL)The blood glucose and lipid metabolism indexes such as LDL-C and high-density lipoprotein(HDL-C)showed a decreasing trend,and the levels of these indexes were significantly lower at 12 months after surgery than at 6 months after surgery(P<0.05).Compared with the preoperative results,the insulin resistance index(Homa-IR)and islet beta cell function(Homa-β)level of the patients were significantly decreased at 6 and 12 months after surgery,and the Homa-IR level at 12 months after surgery was significantly lower than that at 6 months after surgery,and the Homa-βlevel at 12 months after surgery was significantly higher than that at 6 months after surgery(P<0.05).By 12 months after surgery,the remission rate of type 2 diabetes was

关 键 词：腹腔镜胃袖状切除术 肥胖 2型糖尿病 脂肪胰 

分 类 号：R587.1[医药卫生—内分泌] R656[医药卫生—内科学]