单吻合口十二指肠回肠旁路联合袖状胃切除术治疗肥胖症及2型糖尿病的中期疗效分析  

Mid-term efficacy of single anastomosis duodenal-ileal bypass with sleeve gastrectomy in the treatment of obesity and type 2 diabetes mellitus

作　　者：肖明昊 王伦 李世星 刘洋[1] 张峥 胡力夫 陈玉龙 任辉[2] 姜涛[1] Xiao Minghao;Wang Lun;Li Shixing;Liu Yang;Zhang Zheng;Hu Lifu;Chen Yulong;Ren Hui;Jiang Tao(Department of Bariatric and Metabolic Surgery,China-Japan Union Hospital,Jilin University,Changchun 130033,China;Department of General Surgery,Nanhu Branch of China-Japan Union Hospital,Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院减重与代谢外科,长春130033 [2]吉林大学中日联谊医院南湖院区普通外科,长春130033

出　　处：《中华胃肠外科杂志》2024年第10期1056-1062,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：吉林省科学与技术项目(20180101163JC)。

摘　　要：目的评估单吻合口十二指肠回肠旁路联合袖状胃切除术(SADI-S)治疗肥胖症及2型糖尿病的中期疗效。方法为回顾性观察性研究。纳入接受SADI-S治疗的体质指数(BMI)≥40 kg/m^(2)而无论是否合并其他相关代谢病以及BMI 27.5~40.0 kg/m^(2)且合并2型糖尿病(T2DM)的肥胖症患者,排除接受修正手术和随访时间<1年的患者。收集2018年10月至2022年8月期间在吉林大学中日联谊医院接受SADI-S治疗的118例肥胖症患者的临床资料,男性56例,女性62例,年龄(34.5±9.7)岁;术前体质量(125.9±25.0)kg,BMI为(42.8±6.8)kg/m^(2);其中60例患者合并T2DM,其术前空腹血糖为(9.9±3.2)mmol/L,糖化血红蛋白为(8.4±1.7)%。主要观察指标为术后中期的减重效果[包括术后1、2、3、4年的体质量、BMI、多余体质量减少率(%EWL)及总体质量减少率(%TWL)]和治疗糖尿病的疗效,包括术后1、2、3年空腹血糖、糖化血红蛋白及糖尿病缓解率(完全缓解:在不使用降糖药物情况下糖化血红蛋白<6%,或空腹血糖<6 mmol/L;部分缓解:在不使用降糖药物情况下糖化血红蛋白<6.5%,或空腹血糖<7 mmol/L;显著改善:糖化血红蛋白<7.0%,与术前糖化血红蛋白相比稳定下降至少1%,并且术后降糖药物剂量显著下降;无效:糖化血红蛋白无变化,服用药量未减少)。其他观察指标包括术中术后情况以及术后营养素指标。结果所有患者均顺利完成SADI-S手术,手术过程顺利,无明显出血及中转开腹病例,围手术期无死亡病例发生。手术时间(186.1±41.5)min,术后住院时间为6(5~7)d。4例患者出现手术并发症,分别为腹腔积液、颈内静脉血栓、吻合口漏及胃瘘。术后体质量、BMI在术后1、2、3和4年的变化均较术前明显下降,差异均有统计学意义(均P<0.05)。术后1、2、3和4年,%EWL分别为(81.9±16.2)%、(82.2±15.5)%、(88.3±20.1)%和(83.2±18.1)%,%TWL分别为(39.7±8.7)%、(40.6±10.6)%、(42.2±11.5)%和(45.4±10.2)%。术Objective To evaluate the mid-term efficacy of single anastomosis duodenal-ileal bypass with sleeve gastrectomy(SADI-S)in the treatment of obesity and type 2 diabetes mellitus.Methods The cohort of this retrospective observational study comprised 118 obese patients with body mass index(BMI)≥40 kg/m^(2) with or without other related metabolic diseases and BMI of(27.5-40.0)kg/m^(2) with type 2 diabetes mellitus(T2DM)who had been treated with SADI-S.Patients who had undergone modified surgery or been followed up for less than 1 year were excluded.Clinical data of the included patients[56 men and 62 women aged(34.5±9.7)years],who had undergone SADI-S in China-Japan Union Hospital,Jilin University from October 2018 to August 2022,were collected.Their mean preoperative body mass was(125.9±25.0)kg and BMI(42.8±6.8)kg/m^(2).The 60 patients with T2DM had a mean fasting blood glucose of(9.9±3.2)mmol/L and HBA1c of(8.4±1.7)%before surgery.The main outcome measures were mid-term weight loss after surgery(body mass,BMI,excess weight loss,and total weight loss)1,2,3,and 4 years after surgery and efficacy regarding diabetes mellitus(fasting blood glucose,glycated hemoglobin and diabetes remission rate at 1,2,and 3 years after surgery).Outcomes were defined as follows.Complete remission:HbA1c<6%or fasting blood glucose<6 mmol/L without hypoglycemic medication;partial remission:HBA1c<6.5%or fasting blood glucose<7 mmol/L without hypoglycemic medication;significant improvement:HBA1c<7.0%,stable decrease of at least 1%compared with preoperative HBA1c,and postoperative dose of hypoglycemic medication significantly less;ineffective:no change in HBA1c and no reduction in dosage of hypoglycemic medication.Other outcome measures included intraoperative and postoperative adverse effects and postoperative nutritional indexes.Results SADI-S was successful in all patients.There was no significant bleeding,conversion to open surgery,or perioperative death.The operation time was(186.1±41.5)minutes,and the postoperative hospital stay 6

关 键 词：肥胖症 2型糖尿病 单吻合口十二指肠回肠旁路联合袖状胃切除术 中期疗效 

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