腹腔镜Roux-en-Y胃旁路术与腹腔镜迷你胃旁路术治疗2型糖尿病疗效比较

Efficacy comparison between 2 methods of iaparoscopic gastric bypass surgery in the treatment of type 2 diabetes mellitus

目的比较腹腔镜Roux-en-Y胃旁路术（LRYGB）与腹腔镜迷你胃旁路术（LMGB）治疗2型糖尿病（T2DM）的效果及安全性。方法回顾性分析2009年12月至2011年6月问在上海第二军医大学附属长海医院接受腹腔镜胃旁路术治疗的21例T2DM患者的临床资料，其中LRYGB组11例，LMGB组10例。结果LRYGB组T2DM临床完全缓解率为64％（7／11），临床部分缓解率为36％（4／11）；LMGB组临床完全缓解率为60％（6／10），临床部分缓解率为40％（4／10）：两组临床疗效的差异无统计学意义P〉0.05）。两组患者体质量指数、腰围、胰岛素抵抗指数及糖化血红蛋白术后均呈下降趋势（P〈0.05），但两组间差异无统计学意义（p〉0.05）。两组患者手术过程顺利，无中转开腹及死亡病例，LRYcB组手术时间[（147.0±35.9）min]和术后住院时间[（8.9±23）d]均明显长于LMGB组[（110.5±39.7）min，P=0.038：（7.1±1.4）d，P=0.046]。LRYGB组术后出现肠梗阻1例，LMGB组术后出现反流性食管炎和慢性腹泻各1例，两组患者术后并发症发生率的差异无统计学意义（P〉0.05）。结论LRYGB和LMGB对T2DM的治疗效果确切且安全，但LMGB相对简单，术后恢复更快。

Objective To investigate the outcomes after 2 methods of laparoseopic gastric bypass surgery for patients with type 2 diabetes mellitus （T2DM）. Methods From December 2009 to June 2011, 21 patients with T2DM underwent laparoseopie gastric bypass surgery, including laparoseopie Roux-en-Y gastric bypass （LRYGB, n=ll）, and laparoscopie mini-gastric bypass （LMGB, n=10）. Clinical data were analyzed retrospectively. Results The clinical complete remission rate of T2DM was 64% （7/11） in LRYGB group, and 60% （6/10） in LMGB group. The clinical partial remission rate of T2DM was 36%（4/11） in LRYGB group, and 40%（4/10） in the LMGB group. There was no significant difference between the two groups （both P〉0.05）. The levels of BMI, waist circumference, HOMA-IR and HbAlc within the postoperative 6 months were improved in each group （all P〈0.05）, but there was no significant difference between the two groups （all P〉0.05）. There were no conversion or perioperative deaths in both groups. Compared to LMGB, the LRYGB group had longer operative time [（147.0±35.9） rain vs. （110.5±39.7） rain, P=0.038] and postoperative hospital stay [（8.9±2.3） d vs. （7.1±1.4） d, P=0.046）. One patient suffered from ileus in LRYGB group, one patient suffered from reflux esophagitis and one suffered chronic diarrhea in LMGB group. The incidence of postoperative complication was similar between the two groups （P〉0.05）. Conclusion LRYGB and LMGB may result in satisfactory and safe effects for the treatment of T2DM, while the LMGB is simpler and associates with quicker recovery.