腹腔镜下胃旁路手术治疗2型糖尿病26例

Treatment of type 2 diabetes mellitus by laparoscopic gastric bypass:an analysis of 26 cases

目的:总结腹腔镜胃旁路手术治疗2型糖尿病的初步经验.方法:回顾性分析苏州大学附属第一医院2010-05/2010-11开展的腹腔镜下胃旁路手术(LRYGB)治疗2型糖尿病26例的临床资料.患者纳入标准:BMI≥24kg/m2、糖化血红蛋白(HbAlc)≥7%、空腹血清C肽≥1μg/L,患者对手术有强烈的要求,依从性好.术后根据血糖情况逐步减少降糖药物的用量,直至停药;术后1、3、6mo测空腹血糖、血清胰岛素、C肽及HbAlc等指标.结果:26例手术均在腹腔镜下顺利完成,无1例中转开腹.1例术后出现吻合口出血,2例出现胃瘫,经保守治疗后均好转.所有病例均获随访,术后除1例外其余患者均有效控制血糖,有效率为96.3%;11例于术后第3天至第8周内停用所有糖尿病药物,3、6mo的治愈率分别为36.7%、50.0%.结论:腹腔镜下胃旁路手术治疗2型糖尿病安全可行,疗效肯定,但需严格把握手术适应证,其长期疗效仍需进一步临床随访、观察.

AIM： To summarize the initial experience with laparoscopic Roux-en-Y gastric bypass （LRYGB） in the management of patients with type 2 dia- betes mellitus （T2DM）.METHODS： The clinical data for 26 T2DM patients （BMI ≥24 kg/m^2, HbA1c ≥7%, peptide C 91 μg/L） who received laparoscopic gastric bypass from May 2010 to November 2010 were retrospectively analyzed. The changes in FBG, HbA1c, insulin and peptide C levels and in doses of hypoglycemic agents at different postoperative time points （1, 3 and 6 mo） were analyzed. RESULTS： The operation was successful in all cases. Postoperatively, one case developed anastomotic bleeding and 2 cases developed gastroparesis, but they were all cured after conservative medical management. All cases have been followed up and the total effective rate of the operation was 96.3%. Eleven cases were free of dependence on hypoglycemic agents from weeks 3 to 8 after LRYGB, and the 3- and 6-month cure rates were 36.7% and 50%, respectively.CONCLUSION： LRYGP is safe, feasible and effective in the management of T2DM in the short term, and long-term efficacy still need further clinical follow-up.