不同吻合方式胃转流术对2型糖尿病疗效对比研究

Comparative clinical study of the effects of gastric bypass with different types of anastomosis on type 2 diabetes mellitus

目的评估不同吻合方式胃转流术对2型糖尿病的临床疗效。方法 2006年6月至2009年2月南京军区福州总医院收治合并2型糖尿病的胃部病变行胃转流术病人61例,按术式分为毕Ⅰ式(n=11)、毕Ⅱ式(n=26)和Roux-en-Y(n=24)吻合3组。统计分析手术前和术后6个月内体质量指数和糖代谢指标变化。结果术后,Roux-en-Y和毕Ⅱ式组空腹血糖和糖化血红蛋白显著降低、空腹C-肽显著升高、葡萄糖耐量显著改善(P<0.01或P<0.05),且Roux-en-Y组上述指标变化更明显(P<0.01或P<0.05),毕Ⅰ式组未见显著变化(P>0.05)。术后6个月,Roux-en-Y组糖尿病手术总有效率显著高于毕Ⅰ式和毕Ⅱ式组(P<0.01或P<0.05)。结论 Roux-en-Y式胃转流术对2型糖尿病的疗效优于毕Ⅱ式和毕Ⅰ式,并不依赖于体质量的降低,有望成为临床治疗2型糖尿病的有力新手段。

Objective To assess the effects of gastric bypass with different types of anastomosis on type 2 diabetes mellitus （T2DM）. Methods From June 2006 to February 2009, 61 patients with gastric lesions combined with type 2 diabetes mellitus performed gastreetomy were prospectively assigned into Billroth Ⅰ group （n=11）, Billroth Ⅱ group （n=26） and Roux-en-Y group （n=24） in Fuzhou General Hospital of Nanjing Military Command. The pre-and postoperative clinical parameters associated with glycometabolism and body mass index were measured during a 6-month follow-up period. Results Fasting blood glucose and glycated hemoglobin levels were significantly decreased after surgery in both Billroth Ⅱ and Roux-en-Y groups （P〈0.01 or P〈0.05）. At 3 and 6 months, patients in both Billroth Ⅱ and Roux-en-Y groups had significantly increased fasting C-peptide and significant improved oral glucose tolerance test （P〈0.01 or P〈 0.05）. The changes of those parameters above in Roux-en-Y group were greater than those in Billroth Ⅱ group（P〈0.01 or P〈0.05）. However, the effects were not shown in Billroth Ⅰ group through the entire follow-up period. T2DM control rate in Roux-en-Y group was higher than that in Billroth Ⅰ and Billroth Ⅱ group （P〈0.01 or P〈0.05）. Conclusion As compared with Billroth Ⅰand Billroth Ⅱ reconstruction after gastrectomy, Roux-en-Y gastric bypass seems to be more effective on T2DM control. The therapeutic effect of gastric bypass is independent on loss of body weight. Roux-en-Y gastric bypass may be as a potential management option for T2DM.