胃转流术治疗2型糖尿病的临床疗效:附214例报告

Clinical observation of gastric bypass in treatment of patients with type 2 diabetes mellitus

目的 Roux-en-Y式胃转流术(RY-GBP)是2型糖尿病患者接受外科手术治疗的主要术式之一。本研究旨在进一步验证RY-GBP的手术治疗效果。方法 214例2型糖尿病(T2DM)患者均行RY-GBP术,术中根据体质指数和胰岛素抵抗情况,选择合适的残胃(Pouch)容积和空肠袢长度。患者于术前和术后3,6,12个月行OGTT试验,并测定空腹血清胰岛素(FIns)、空腹血清C肽(FC-P)、糖化血红蛋白(HbAlc)、体重指数(BMI),密切关注患者术后的降糖药服用情况及糖尿病并发症改善情况。结果 214例患者中,51例(23.8%)术后出院时即达治愈标准,停用降糖药物,78例(36.4%)于术后0～3个月内停药,21例(9.8%)于术后3～6个月内停药,18例(8.4%)于术后6～12个月内停药。另外46例(21.5%)12个月后仍服用降糖药物,但药物剂量有不同程度地减少,尚在进一步观察中。上述病例在术后3,6,12个月的各项检测指标均有所改善,近期治愈率达78.5%(168/214)。本组无死亡病例,相关并发症包括吻合口出血2例,吻合口溃疡7例,胃瘫21例,营养不良3例,贫血8例,在给予相应治疗后均缓解。结论 RY-GBP胃转流术对肥胖型和非肥胖型2型糖尿病均有良好治疗效果,对非肥胖型2型糖尿病的治疗效果更值得进一步深入研究。

Objective Gastric bypass（GBP）,especially Roux-en-Y,is the main surgical procedure in patients with type 2 diabetes mellitus（T2DM）.The present study focused on the evaluation of efficiency of Roux-en-Y Gastric bypass（RY-GBP） in T2DM patients.Methods Two hundred and fourteen patients with T2DM were operated according to the RY-GBP procedures,and gastric pouch as well as Roux limb were selected respectively by the BMI and insulin resistance.Blood glucose alterations（OGTT）,Fins,FC-P,HbAlc,BMI,related complications and anti-sugar drugs were observed at four phases（before the operation,3 months,6 months,12 months after operation）.Results Among 214 T2DM patients,51（23.8%） were cured at the time of discharge without anti-sugar drugs,the same with the others：78（36.4%） at three months,21（9.8%） between 3-6 months,18（8.4%） during 6-12 months.Although 46 patients（21.5%） were still to be given anti-sugar drugs,dosage decreased markedly and follow-up of them were ongoing.The chemical data and other indexes were recovered in total 168 patients,which indicated healing rate 78.5%（168/214）.There was no death in our group except some complications,such as anastomotic stoma bleeding（2 cases）,anastomotic stoma ulcer（7 cases）,gastroplegia（21 cases）,nutritional disturbance（3 cases）,anaemia（8 cases）,which were relieved with symptomatic treatment.Especially,patients with malnutrition or anaemia were non-obese（BMI 24 kg/m2）。 Conclusion RY-GBP present wonderful therapeutic effects in obese patients and non-obese patients,especially the mechanism in non-obese patients is worth to be further investigated.