减重代谢手术治疗重度肥胖合并2型糖尿病术后1年疗效分析

One-year outcome of bariatric surgery in severe obesity patients with type 2 diabetes mellitus

目的:比较分析腹腔镜胃袖状切除术与腹腔镜胃转流术治疗重度肥胖合并2型糖尿病患者的短期效果。方法:回顾分析48例合并2型糖尿病重度肥胖症患者的临床资料。按手术方式分为胃袖状切除组(n=30)与胃转流组(n=18),术后随访1年,分析比较两组患者体重改善情况及相关糖脂代谢指标的变化。结果:48例均顺利完成手术。术后两组患者体质指数均明显低于术前(P<0.01),两组间差异无统计学意义(P>0.05)。术后6个月、12个月,两组患者空腹血糖、糖化血红蛋白、空腹C肽、胰岛素抵抗指数、胆固醇、甘油三酯均较术前明显改善(P<0.01)。胃袖状切除组与胃转流组糖尿病完全缓解率分别为73%与78%,两组有效率均为100%,两组缓解率相比差异无统计学意义(P>0.05)。结论:腹腔镜胃转流手术与腹腔镜胃袖状切除术均可有效治疗重度肥胖合并糖尿病,近期效果显著,且两种治疗方法临床效果相近。

Objective： To evaluate the short-term effects of bariatric surgery for type 2 diabetes mellitus（ T2DM） with severe obesity. Methods： Clinical data of 48 severe obesity patients with T2DM were retrospectively analyzed. 30 patients were performed laparoscopic sleeve gastrectomy（ LSG） and the others were performed laparoscopic Roux-en-Y gastric bypass（ LRYGB）. All the patients were followed for 12 months. Clinical records including preoperative and postoperative body mass index（ BMI）,fasting plasma glucose（ FPG）,hemoglobin A1c（ HbA1c） levels,fasting C-peptide（ C-P）,blood lipid levels,and diabetes remission rate were analyzed. Results： All 48 surgeries were performed successfully. The mean BMI was significantly lower than baseline（ P 0. 01）,and there was no significant difference between the two groups（ P 0. 05）. Patients in both groups had significant decrease in FPG,HbA1c,C-P and blood lipid levels at 6 th and 12 th month after surgery（ P 0. 01）. The effective rate was 100% in both groups. The diabetes remission rate was 73% in LSG group and 78% in LRYGB group,but the difference was not statistically significant. Conclusions： Both LSG and LRYGB can effectively treat severe obesity combined with diabetes with a significant short-term effect and similar clinical effect.