3D腹腔镜Roux-en-Y胃旁路术与袖状胃切除术治疗肥胖症合并2型糖尿病临床疗效的比较

The comparative analysis of clinical efficacy of laparoscopic Roux -en -Y gastric bypass vs.lapa- roscopic sleeve gastrectomy in treatment of obesity combined with type 2 diabetes melfitus

目的对比分析腹腔镜Roux-en-Y胃旁路术(LRYGB)和腹腔镜袖状胃切除术(LSG)治疗肥胖症合并2型糖尿病(T2DM)的可行性、安全性及临床疗效。方法收集我院收治的48例肥胖症合并T2DM患者资料。按照手术方式分为LRYGB组和LSG组。术后随访1年,对比分析两组患者手术和术后恢复情况、减重及降糖效果。结果48例患者均顺利完成手术,无中转开腹。两组患者术后均无吻合口漏、出血及狭窄等严重并发症发生和围手术期死亡。与LRYGB组比较,LSG组手术时间明显缩短(P<0.05),术中出血量明显减少(P<0.05),术后胃肠功能恢复时间明显缩短(P<0.05),下床活动时间明显缩短(P<0.05)。术后住院时间明显缩短(P<0.05)。48例患者均获得术后随访。与术前比较,LRYGB组和LSG组患者术后3、6、12个月体重、BMI、腰围、臀围、腰臀比均显著降低(P均<0.05)。两组患者减重效果均显著。与术前比较,LRYGB组和LSG组患者术后3、6、12个月空腹血糖、空腹胰岛素、空腹C肽、糖化血红蛋白均明显降低(P均<0.05)。两组患者降糖效果均显著。相同时间点,两组间上述指标比较差异均无统计学意义(P均>0.05)。LRYGB组和LSG组糖尿病缓解率分别为90%和92.86%,有效率均为100%,两组间差异无统计学意义(P>0.05)。结论 LRYGB和LSG治疗肥胖症合并T2DM安全可行,近期临床效果显著,且治疗效果相近。LSG术式简单且术后恢复快,可作为优先考虑实施的术式。

Objective To comparatively analyze the feasibility, safety and clinical efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) vs. laparoscopic sleeve gastrectomy (LSG) in treatment of obesity combined with type 2 diabetes mellitus (T2DM).Methods The retrospetive cross-sectional study was conducted. The clinical data of 48 patients who underwent surgical treatment in our hospital between January 2014 and June 2017 were collected. Twenty patients were given LRYGB and 28 patients LSG. All the patients were followed up for 1 year. The surgical and postoperative recovery situations, the effect of weight reduction and hypoglycemic effect were compared between the two groups.Results The operations were performed successfully on 48 patients, without conversion to open surgery. There were no postoperative complications (anastomotic leak, bleeding and stenosis, etc) and perioperative deaths. As compared with LRYGB group, operation time, time of postoperative gastrointestinal function recovery, time of out of bed and duration of hospital stay were significantly shortened, and volume of intraoperative blood loss was significantly reduced in LSG group (P<0.05 for all). As compared to pre-operation, in LRYGB and LSG groups, the average body weight, BMI, waist circumference, hip circumference and waist-hip ratio were significantly decreased at 3rd, 6th and 12th month after operation (P<0.05 for all). Meanwhile, as compared to pre-operation, in LRYGB and LSG groups, the average fasting blood glucose (FBG), the fasting serum inculin (FINS), the fasting C-peptide and the HbA1c were significantly reduced at 3rd, 6th and 12th month after operation (P <0.05 for all). There were no significant difference in the above indexes between the two groups at the same time points (P>0.05 for all). The remission rate of T2DM at 12th month postoperatively was 90% in LRYGB group and 92.86% in LSG group, with an effective rate of 100.0%. Moreover, there was no statistically significant difference between the two groups (P>0.05).Conclusion Both LRYGB and LSG are safe and effective in the treatment of obesity combined with T2DM, with a good short-term outcome and similar clinical effect. The LSG can be considered as a priority operation for its simple procedure and quick postoperative recovery.