腹腔镜下胃转流术治疗肥胖型2型糖尿病的疗效分析

Effect of Laparoscopic Gastric Bypass on Obesity Related Type 2 Diabetes

目的探讨腹腔镜下胃转流术治疗肥胖型2型糖尿病的短期和长期临床效果。方法回顾性分析四川大学华西医院2009年11月至2012年2月期间开展腹腔镜下胃转流手术治疗肥胖型2型糖尿病20例患者的病例资料,根据随访时间的不同,分为<1年(20例)的短期疗效分析和≥1年(11例)的长期疗效分析两个部分。观察术后患者体重、血糖、糖化血红蛋白、胰岛素抵抗水平、血压和血脂控制情况。计算糖尿病短期有效率和长期缓解率,并分析影响糖尿病缓解的因素。结果术后1年内,患者平均体重、血糖和糖化血红蛋白均明显降低,胰岛素抵抗减轻,手术对高血压和血脂紊乱也有明显治疗效果,糖尿病短期有效率为90.0%(18/20),短期内血糖和用药均达完全缓解标准的患者比例为9/20(45.0%),糖尿病病程和术前C-肽水平与短期缓解率有关。长期随访病例,术后平均体重和血糖、糖化血红蛋白明显降低,胰岛素抵抗减轻,高血压和血脂紊乱得到有效控制,手术使糖尿病长期缓解者的比例为9/11(81.8%),临床治愈者比例为6/11(54.5%),糖尿病病程和空腹血糖水平与糖尿病缓解有关。手术不良反应少,患者满意度较高。结论腹腔镜下胃转流术治疗肥胖型2型糖尿病的短期和长期临床效果明显,是较为安全而有效的外科干预糖尿病的方式。

Objective To investigate the short term and long term effects of laparoscopic gastric bypass on obesity related type 2 diabetes.Methods Twenty obese patients with type 2 diabetes underwent laparoscopic gastric bypass between Nov.2009 and Feb.2012 were identified in the computer database of West China Hospital of Sichuan University.All patients had short term follow-up of less than 1 year and among them 11 were with long term follow-up of 1 year or more.Body weight,body mass index（BMI）,blood glucose,glycosylated hemoglobin（HbA1c）,homeostasis model assessment of insulin resistance-insulin resistance（HOMA-IR）,blood pressure,and blood lipids were examined.Short term（1 year） and long term（≥1 year） remission rates of diabetes were calculated and factors which might have effects on the remission of diabetes were analyzed.Results Of patients with short term follow-up, body weight,fasting plasma glucose（FPG）,2h plasma glucose（2hPG）,HbA1c,and HOMA-IR were reduced significantly.Among them,18 of 20 patients（90.0%） reached the glucose and medication standards of complete remission and partial remission,9 patients were defined as completely remitted（9/20,45.0%）.Those accompanied with hypertension and（or） hyperlipemia were all improved clinically.The duration of diabetes,fasting and 2 h C peptide were found to be related to short term diabetes remission.Patients with long term follow-up of 1 year or more were observed to have significant reductions in body weight,FPG,2hPG,HbA1c,and HOMA-IR as well.Hypertension and hyperlipidemia were all well controlled.The remission rate of diabetes reached 9/11（81.8%）and those who were defined as completely remitted took a proportion of 6/11（54.5%）.In these patients,those who did not reach the standards of complete remission had longer duration of diabetes and higher FPG when compared with those who did.No severe adverse event was found during the follow-up in either group.Most patients investigated were satisfied with the surgery. Conclusion Laparoscopic gastric bypass is effective and safe on short term and long term treatment of obesity related type 2 diabetes.