微创减重手术治疗2型糖尿病

Microinvasive bariatric operations relieve type 2 diabetes

目的探讨3种临床常用微创减重术式在控制病态性肥胖症伴2型糖尿病的疗效。方法统计中国医科大学附属盛京医院2005-2009年接受胃绑带术（7例）、袖带胃切除术（7例）和胃转流术（4例）共18例患者术后3、6、12个月的体质量指数（BMI）变化、空腹和餐后2h血糖、糖化血红蛋白含量，对3种手术控制体重、血糖和糖化血红蛋白的效果进行分析。结果本组18例患者均无中转开腹，无术后消化道漏、术后营养不良等严重并发症。各组患者术后体重均明显下降，术后1年BM[分别为（27．6±2．0）kg／m^2、（26．9±I．4）kg／m^2、（27．5±3．0）kg／m^2，各组之间比较差异均无统计学意义（均P〉0．05）。术后1年各组额外BMI丢失分别为（76．4％±6．8％）、（83．7％±4．6％）、（85．7％±9．5％），组问比较差异均无统计学意义，而各组患者手术前后比较差异有统计学意义（P〈0．01）。手术后各组空腹血糖和餐后2h血糖均明显下降，其中胃转流术组空腹血糖和餐后2h血糖均降至正常，与其他两组比较差异有统计学意义（P〈0．05）。术后6个月和12个月胃转流术组糖化血红蛋白分别为6．5％±0．1％和5．7％±0．1％，明显低于其他两组（P〈0．05）。结论3种手术均具有一定的控制肥胖患者体重和空腹血糖的作用，胃旁路转流术控制体重和血糖的效果明显优于其他两种术式。袖带胃切除术具有稳定控制体重和血糖的作用，总体效果优于胃绑带手术。

Objective To investigate the effects of three laparoscopic bariatric operations on relieving type 2 diabetes in morbid obese patients. Methods From 2005 to 2009, 15 morbid obese patients with type 2 diabetes received bariatric operations in Shengjing Hospital including lapband operation （7 cases）, sleeve gastrectomy （7 cases） and gastric bypass （4 cases）. All patients were followed up for more than 1 year. Results All patients recovered without major complications. Body weight decreased and BM｜ was respectively （27.6 ±2.0） kg/m^2, （26.9±1.4） kg/m^2 and （27.5 ±3.0） kg/m^2 1 year after operation. The excess BMI loss in three groups were （76. 4%± 6. 8% ）, （ 83.7% ±4. 6% ）, （85.7% ±9.5% ） 1 year after operation. On the other side, the fasting glucose levels and glycohemoglobin in gastric bypass group were much lower than that in other two groups. Conclusion All these operations were effective in controling the weights and fasting glucose levels, while the gastric bypass method is better than other two methods in weight and serum glucose control. Sleeve gastrectomy was better in weight and glucose control than lap band operation.