腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病62例分析

Analysis of laparoscopic Roux.en-Y gastric bypass in treating 62 cases of type 2 diabetes mellitus

目的探讨腹腔镜Roux—en-Y胃旁路术（LRYGB）在2型糖尿病治疗中的临床应用。方法回顾性分析2010年5月至2011年10月间在苏州大学附属第一医院接受LRYGB手术的62例2型糖尿病患者的临床和随访资料。结果62例患者中58例顺利完成LRYGB术．手术时间（144．5±59．0）min，术中出血量（57.8±135．5）ml。术后吻合口出血2例，胃瘫2例，吻合口瘘1例．营养不良1例，均经保守治疗缓解；另有1例吻合口狭窄患者。经球囊扩张后缓解。49例患者获得了术后6个月的随访，其中34例临床完全缓解（完全停药），9例临床部分缓解（用药量较术前减少），6例无效。患者术后体质量指数、空腹血糖、糖化血红蛋白均较术前有明显改善（均P〈0．05）。与术后仍需服用降糖药者相比，临床完全缓解的病例术前体质量指数更高、病程更短（均P〈0．05）。结论LRYGB用于治疗2型糖尿病安全、可行，短期效果良好．长期效果有待观察。

Objective To evaluate the efficacy of laparoscopic Roux-en-Y gastric bypass （LRYGB） in the treatment of type 2 diabetes mellitus （T2DM）. Methods Clinical data of 62 cases undergoing LRYGB from May 2010 to October 2011 were analyzed retrospectively. Results LRYGB was completed in 58 patients successfully. The mean operative time was（144.5±59.0） rain and the mean intraoperative blood loss was （57.8±135.5） ml. Postoperatively two patients developed anastomotic bleeding, one gastric paralysis, one anastomotic leak, and one malnutrition, which were all healed by conservation treatment. One patient developed anastomotic stricture which was alleviated by balloon dilatation. Forty-nine cases were followed up for six months, in whom 34 patients required no further medical treatment, 9 received less medicines, and 6 were inactive. Body mass index, fasting C-peptide, and HbAlc were improved postoperatively. Compared to other patients, the 34 patients with clinical complete remission had higher BMI and shorter disease course （both P〈0.05）. Conclusions LRYGB can safely and efficiently be applied in T2DM patients. Short-term efficacy is satisfactory and the long- term outcomes require further evaluation.