腹腔镜Roux-en-Y吻合术治疗肥胖型和非肥胖型2型糖尿病疗效分析

Clinical Analysis on the Efficacy of Laparoscopic Roux-en-Y Gastric Bypass for Obese and Non-obese Type-2 Diabetes Mellitus

目的:探讨腹腔镜Roux-en-Y胃旁路手术(LRYGB)治疗肥胖型和非肥胖型2型糖尿病(T2DM)的疗效和疗效差异。方法:回顾性分析我院2010年1月至2012年12月收治的72例行LRYGB的T2DM的临床资料,其中肥胖组42例,非肥胖组30例。结果:两组患者术中均无损伤大血管、肠管等严重并发症,无中转开腹病例。两组患者手术出血量、术后初次下床活动时间、术后排气时间、术后并发症发生率无明显统计学差异(均P>0.05);肥胖组手术时间高于非肥胖组(P=0.039)。术前肥胖组与非肥胖组空腹血糖(FBG)、餐后2h血糖(2h PBG)、糖化血红蛋白(HbA1c)、空腹C肽、胰岛素抵抗指数(Homa-IR)、胰岛功能指数(Homa-β)比较无明显统计学差异(均P>0.05)。术后两组患者FBG、2h PBG、HbA1c、Homa-IR较术前均有所下降,空腹C肽、Homa-β均有所升高(均P<0.05)。肥胖组术后FBG、2h PBG、空腹C肽、Homa-IR、Homa-β与非肥胖组无明显统计学差异(均P>0.05);HbA1c较非肥胖组要低(P<0.05)。肥胖组临床有效率为92.86%,高于非肥胖组83.33%,但差异不具有统计学意义(X2=1.607,P=0.205)。结论:腹腔镜Roux-en-Y胃旁路手术治疗肥胖型和非肥胖型2型糖尿病短期疗效均较好,长期疗效需待随访。

Objective： To explore the efficacy of laparoscopic Roux-en-Y gastric bypass（ LRYGB） for patients with obese and non-obese type-2 diabetes mellitus（ T2DM）,and compare the difference. Method：Clinical data of 72 patients with T2DM undergoing LRYGB from January 2010 to December 2012 were analyzed retrospectively. They were divided into the obese group（ n = 42） and the non-obese group（ n = 30）.Result： All of the patients underwent the operation without serious intraoperative complications,and no patient was converted to open surgery. The blood loss,time to resume early activity,postoperative exhaust time,and the incidence of complications were compared between two groups（ All P 0.05）. The operative time in the obese group was more than that in the non-obese time（ P = 0.039）. The differences of the preoperative level of FBG,2hPBG,HbA1c,the peptide C,Homa-IR and Homa-β between the two groups were no significant（ All P〈0.05）,and the postoperative result was similar（ All P〉0.05） except the HbA1c（ P〉0.05）. Ther＇s no difference for the effective rate between the two groups（ 92.86% vs. 83.33%）（ X^2= 1.607,P = 0.205）. Conclusion： LRYGB for obese and non-obese T2DM can get a good efficacy in the short term,but the long-term efficacy need to be further observed.