腹腔镜下Roux-en-Y胃旁路术治疗肥胖2型糖尿病患者的近期疗效分析

Short-term efficacy of laparoscopic Roux-en-Y gastric bypass in obese patients with type 2 diabetes

目的观察腹腔镜下Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)在肥胖2型糖尿病患者治疗中的近期临床疗效和安全性。方法纳入我院近3年来行LRYGB手术的肥胖2型糖尿病患者12例,其中男性4例,女性8例;年龄(43.8±10.6)岁;糖尿病病程(8.3±3.9)年;体质量指数(31.3±5.6)kg/m2;空腹血糖(9.4±1.9)mmol/L;HbA1c(8.4±1.6)%。患者均完成术后12个月的随访。以术后停用所有降糖治疗,空腹血糖<7.0 mmol/L和HbA1c<6.5%者,判定为2型糖尿病临床完全缓解。观察手术后患者体质量、血糖、血脂、血压、用药用量等变化以及术后相关并发症情况。结果 LRYGB术后12个月患者显著降低体质量(20.4±9.7)kg,显著缩小腰围(23.4±14.1)cm,同时降低HbA1c(2.1±1.7)%。2型糖尿病临床完全缓解7例(58.3%),临床部分缓解5例(41.7%)。合并有高血压病、血脂异常的患者术后均停用所有降压、降脂药物。与临床部分缓解组相比,临床完全缓解组的糖尿病病程更短[(4.6±3.3)年vs(10.6±3.7)年,P<0.05]。12例患者无1例死亡。患者术后近期并发症发生1例(8.3%),远期并发症发生1例(8.3%)。结论 LRYGB治疗肥胖2型糖尿病患者的近期临床疗效满意,能有效控制患者的血糖、血脂及血压。

Objective To evaluate the short-term clinical efficacy and safety of laparoscopic Roux-en-Y gastric bypass （LRYGB） in obese patients with type 2 diabetes mellitus （T2DM）. Methods Twelve obese T2DM patients undergoing LRYGB from May 2010 to August 2013 were recruited in this study. They were 4 males and 8 females, with a mean age of 43.8 ± 10.6 years, a mean duration of T2DM for 8.3 ± 3.9 years, a body mass index of 31.3 ＋5.6 kg/m2, fasting plasma glucose of 9.4 ± 1.9 mmol/L, and HbAlc of （8.4 ± 1.6） % before surgery. The cohort was followed up for a period of 12 months. Main outcome measures were the rate of diabetes remission （ complete remission of diabetes was defined as a fasting plasma glucose level of less than 7.0 mmol/L and I-IbAlc level less than 6.5% without active phaxmacologic therapy）. Data on demographics, lipid profiles, blood pressure, levels glucose and I-IbAlc, medication, and remission were prospectively collected and analyzed with post-operative data. Results In 12 months after LRYGB, there were significant decreases in body weight （20.4 ± 9.7 kg）, waist circumference （23.4 ± 14.1 cm）, and in HbAlc [ （2.1 ±1.7 ）% ]. There were 7 patients （58.3%） having T2DM complete remission, and 5 （41.7%） with partial remission. For the patients complicated with hypertension and/or dyslipidemia, their antihypertensive agents and lipid-lowering drugs were stopped to use after surgery. The group achieving T2DM complete remission had a shorter duration of diabetes compared with the partial remission group（4.6 ± 3.3 years vs 10.6 ± 3.7 years ,P 〈 0.05 ）. There wasno mortality, and one （8.3%） patient experienced early complications and another one （8.3%） with the long term complications. Conclusion LRYGB has satisfying short-term outcomes in the treatment of obese T2DM, with well control on blood glucose, lipids and bood pressure