腹腔镜胃旁路术治疗肥胖型2型糖尿病的疗效评价

Efficacy evaluation of laparoscopic gastric bypass for the treatment of obese type 2 diabetes mellitus

目的探讨腹腔镜Roux—en—Y胃旁路术（LRYGB）治疗肥胖型2型糖尿病的临床疗效。方法回顾性分析2009年3月至2011年2月间在北京世纪坛医院接受LRYGB治疗的18例肥胖型2型糖尿病患者的临床资料．分别于术前及术后3个月检测血糖、血脂及营养指标，记录减重情况。结果18例患者中男8例，女10例，年龄27～62（42．4±10．7）岁，BMI28．7～57．4（34．9±6．9）kg／m2。全组患者均在腹腔镜下完成手术。无中转开腹，无围手术期死亡及并发症发生。术后3个月，患者体质量明显下降，空腹及餐后血糖水平、糖化血红蛋白、胰岛素抵抗指数、胰岛功能指数均较术前显著好转（均P〈0．05）：临床完全缓解率为77．8％（14／18），总有效率为100％（18／18）。术后3个月时患者血脂水平亦明显下降（P〈0．05），营养指标手术前后的比较，差异无统计学意义（均P〉0．05）。结论LRYGB可以有效地治疗肥胖型2型糖尿病。

Objective To explore the treatment outcomes of obese type 2 diabetes mellitus （T2DM） after laparoscopic gastric bypass. Methods The clinical data of 18 patients with obese T2DM who underwent laparoscopic Roux-en-Y gastric bypass in Beijing Shijitan Hospital between March 2009 and February 2011 were retrospectively analyzed. The clinical parameters included preoperative and postoperative blood glucose, blood lipid, nutrition status and weight lose. Results Eighteen patients included 8 men and 10 women. The range of age was 27-62 years （mean, 42.4±10.7 years）. The range of BMI was 28.7-57.4 kg/m2 （mean, 34.9±6.9 kg/m2）. All the patients underwent laparoscopic Roux- en-Y gastric bypass, and no mortality, complication or conversion to open operation occurred. At 3 months after operation, there were significant changes in OGTI＇, BMI, HbAlc, Homa-IR and Homa-β （all P〈0.05）. Fourteen patients （77.8%） showed clinical complete remission, and the overall effective rate was 100% （18/18）. The level of blood lipid decreased significantly （P〈0.05）, and the change of nutritional status was not statistically significant （P〉0.05）. Conclusion Gastric bypass is an effective treatment for obese type 2 diabetes mellitus.