腹腔镜Roux-en-Y胃分流术治疗病态性肥胖合并2型糖尿病

Efficacy of iaparoscopic Roux-en-Y gastric bypass in the treatment of morbid obesity complicated with type 2 diabetes mellitus

目的评价腹腔镜Roux-en-Y胃分流术（LRYGB）对病态性肥胖合并2型糖尿病患者的治疗效果，探讨该术式治疗糖尿病的可能机制。方法前瞻性分析2007年1月至7月美国克利夫兰医院30例体质量指数（BMI）≥35．00合并2型糖尿病的病态性肥胖患者的临床资料，采用t检验分析患者接受LRYGB后的疗效。结果与术前比较，术后第6个月的BMI、空腹血糖、糖化血红蛋白明显降低（t=27．399，23．025，15．593，P〈0．05）。第2个月治愈率为70％（21／30），第6个月治愈率为90％（27／30），3例糖尿病症状得到改善。进一步分析术后第2个月和第6个月体质量下降程度，改善患者分别为27．89％±5．51％、45．73％±2．82％，治愈患者分别为35．65％±1．97％、58．00％±1．05％，糖尿病治愈患者比改善患者下降幅度大（t=5．755，7．081，P〈0．05）。结论LRYGB对病态性肥胖合并2型糖尿病患者有着良好治疗效果，体质量下降幅度越大，糖尿病治愈可能性就越大。

Objective To evaluate the efficacy of laparoscopic Roux-en-Y gastric bypass （LRYGB） in the treatment of morbid obesity complicated with type 2 diabetes mellitus, and to discuss the mechanism of LRYGB in the treatment of type 2 diabetes mellitus. Methods The clinical data of 30 type 2 diabetes mellitus patients with body mass index （BMI）≥35.00 who had undergone LRYGB from January 2007 to July 2007 in Cleveland Clinic were prospectively analyzed. The pre-and postoperative clinical parameters were analyzed by t test. Results The BMI, fasting plasma glucose and glycosylated hemoglobin were significantly decreased 6 months after the operation （ t = 27. 399, 23. 025, 15. 593, P 〈 0.05）. The cure rate at the end of the second month was 70% （21/30）, and it was increased to 90% at the end of sixth month （27/30）. The condition of the remaining 3 patients were improved. At the end of the second and sixth month after operation, the BMIs of the patients who were cured by LRYGB were decreased by 27.89%±5.51% and 45.73%±2.82% , and the BMts of the patients whose condition was improved were decreased by 35.65%±1.97% and 58.00%±3.05% （ t = 5. 755, 7.081 , P 〈 0. 05）. Conclusions LRYGB is effective in the treatment of morbid obesity complicated with type 2 diabetes mellitus. The curability of morbid obesity increases as the BMI decreases.