胃袖状切除术与Roux—en—Y胃旁路术治疗2型糖尿病疗效的Meta分析

Efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes melli- tus a Meta-analysis

目的系统评价胃袖状切除术与Roux—en—Y胃旁路术治疗2型糖尿病的疗效。方法以减重手术、胃切除术、胃绕道术、胃旁路手术、胃转流术、胃袖状切除术、糖尿病、bariatricsurgery、gastricbypass、sleevegastrectomy、diabetes、T2DM等为关键词检索Cochranelibrary、PubMed、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库和万方数据库。检索时间为各数据库建库至2012年12月。最终纳入胃袖状切除术对比Roux—en—Y胃旁路术治疗2型糖尿病的相关文献，再由2名研究者分别独立提取数据并进行文献质量评价，用RevMan5．1．2软件进行Meta分析。计数资料采用相对危险度（riskratio，RR）或比值比（oddsratio，OR）分析统计，计量资料采用均数差（meandifference，MD）或标准差（standardmeandifference，SMD）分析统计。采用Jr2对异质性进行定量分析。结果共纳入符合标准的文献5篇，其中胃袖状切除术组164例，Roux—en—Y胃旁路术组184例。Meta分析结果显示：与胃袖状切除术比较，Roux—en—Y胃旁路术能更显著地提高患者糖尿病的缓解率（OR=0．48，95％C／：0．26～0．91，P〈0．05），提高随访期间停止服药的比例（OR=0．37，95％C／：0．16～0．84，P〈0．05），更有效降低糖化血红蛋白水平（MD=0．28，95％C／：0．14—0．43，P〈0．05）和体质量（MD=-0．44，95％CI：-0．76～-0．13，P〈0．05）。胃袖状切除术与Roux—ell—Y胃旁路术患者术后并发症发生率比较，差异无统计学意义（OR=1．81，95％C／：0．20～16．73，P〉0．05）。结论Roux—en—Y胃旁路术较胃袖状切除术在治疗2型糖尿病的疗效方面具有一定的优势。

Objective To review the efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus. Methods The Cochrane library, PubMed, China Journal Full Text Data- base, Chinese Scientific Journal Full Text Database, Chinese Biomedical Literature Database and Wanfang Data- base were searched with key words including ＂bariatric surgery＂, ＂gastric bypass＂, ＂sleeve gastrectomy＂, ＂diabe- tes＂, ＂T2DM＂ and et al. Literatures published between the time of database establishment and December 2012 were searched. Literatures focused on the comparison of the efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus were retrieved. Data extraction and quality evaluation of the literatures were done by 2 researchers independently. Meta analysis was performed by RevMan 5.1.2 software. The count data were presented by risk ratio （RR） or odds ratio （OR） , and the measurement data were presented by mean difference （MD） or standard mean difference （SMD）. The heterogeneity of the literatures was analyzed by I2. Results Five literatures were retrieved, including 164 patients in the sleeve gastrectomy group and 184 patients in the Roux-en-Y gastric bypass group. The results of Meta analysis showed that Roux-en-Y gastric bypass could significantly increase the remission rate of type 2 diabetes （OR =0. 48, 95% confidence interval： O. 26-0. 91, P 〈 0.05 ）, increase the percentage of patients without drugs during follow up （ OR = 0. 37, 95 % confidence interval ： 0. 16-0. 84, P 〈 0.05） , decrease the levels of HbAle and body weight （MD = 0. 28, -0. 44, 95% confidenceinterval ： 0. 14-0.43, - 0. 76-- 0. 13, P 〈 0.05 ） when compared with sleeve gastrectomy. There was no significant difference in the incidence of complications between the 2 groups （OR = 1.81, 95% confidence interval： O. 20- 16. 73, P 〉 0.05 ）. Conclusion Roux-en-Y gastric bypass is superior to sleeve gastrectomy for patients with type 2 diabetes.