腹腔镜胃旁路术和袖状胃切除术治疗肥胖合并2型糖尿病患者的长期疗效比较

A long-term result of laparoscopic Roux-en-Y gastric bypass vs. laparoscopic sleeve gastrectomy in the treatment of obese patients with type 2 diabetes mellitus

目的比较腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)和袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)治疗肥胖合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者的长期疗效。方法回顾性分析2010年1月至2013年6月在北京世纪坛医院接受LRYGB和LSG的63例T2DM患者,按手术方式分为两组:LRYGB组28例,LSG组35例。结果术后1、3、5年,两组患者的BMI、空腹血糖、空腹胰岛素、HbA1c、胰岛素抵抗指数均较术前明显降低[LRYGB组:(37.3±3.7)kg/m2比(32.3±3.4)kg/m2比(28.8±3.0)kg/m2比(25.5±2.8)kg/m2,t=13.670,15.499,21.710,P=0.000,0.000,0.000;(8.2±1.8)mmol/L比(6.0±1.3)mmol/L比(5.2±0.9)mmol/L比(4.7±0.5)mmol/L,t=6.664,8.723,10.282,P=0.000,0.000,0.000;(32.2±17.0)μIU/ml比(16.1±12.1)μIU/ml比(8.6±5.2)μIU/ml比(5.2±2.8)μIU/ml,t=7.453,8.218,8.687,P=0.000,0.000,0.000;(7.4%±0.6%)比(6.2%±0.7%)比(5.7%±0.7%)比(5.1%±0.6%),t=11.362,18.771,21.186,P=0.000,0.000,0.000;(12.0±7.3)比(4.6±4.3)比(2.1±1.7)比(1.1±0.7),t=6.455,7.667,8.050,P=0.000,0.000,0.000。LSG组:(39.2±5.2)kg/m2比(34.1±4.5)kg/m2比(29.3±4.0)kg/m2比(25.1±2.3)kg/m2,t=11.676,13.680,19.161,P=0.000,0.000,0.000;(8.0±2.9)mmol/L比(5.8±1.5)mmol/L比(5.1±0.9)mmol/L比(4.6±0.5)mmol/L,t=5.467,6.921,7.741,P=0.000,0.000,0.000;(29.1±25.2)μIU/ml比(16.4±10.6)μIU/ml比(8.8±5.5)μIU/ml比(5.5±2.0)μIU/ml,t=3.512,5.232,5.702,P=0.001,0.000,0.000;(7.7%±1.3%)比(6.3%±0.6%)比(5.8%±0.6%)比(5.2%±0.6%),t=8.001,10.106,11.922,P=0.000,0.000,0.000;(9.8±9.6)比(3.9±2.2)比(1.9±1.0)比(1.1±0.4),t=3.733,4.972,5.404,P=0.001,0.000,0.000]。两组患者手术前后的BMI、空腹血糖、空腹胰岛素、HbA1c、胰岛素抵抗指数差异均无统计学意义(均P>0.05)。两组患者术后1、3、5年的糖尿病完全缓解率差异均无统计学意义(71%比69%、89%比80%、93%比89%,均P>0.05)。结论LRYGB和LSG治疗T2DM患者的长期疗效相同。

Objective To compare laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy for the treatment of obese patients with type 2 diabetes mellitus. Methods A retrospective analysis of T2DM patients with LRYGB (28 cases) and LSG (35 cases) was enrolled from Jan 2010 to Jun 2013. Results The indicator such as BMI,fasting glucose,fasting insulin,HbA1c,and insulin resistance were significantly lower in 1 year,3 years and 5 years after operation [LRYGB group: (37.3±3.7) kg/m2 to (32.3±3.4) kg/m2 to (28.8±3.0) kg/m2 to (25.5±2.8) kg/m2,t=13.670,15.499,21.710,P=0.000,0.000,0.000;(8.2±1.8) mmol/L to (6.0±1.3) mmol/L to (5.2±0.9) mmol/L to (4.7±0.5) mmol/L,t=6.664,8.723,10.282,P=0.000,0.000,0.000;(32.2±17.0) μIU/ml to (16.1±12.1) μIU/ml to (8.6 ±5.2) μIU/ml to (5.2±2.8) μIU/ml,t=7.453,8.218,8.687,P=0.000,0.000,0.000;(7.4%±0.6%) to (6.2%±0.7%) to (5.7%±0.7%) to (5.1%±0.6%),t=11.362,18.771,21.186,P=0.000,0.000,0.000;(12.0±7.3) to (4.6±4.3) to (2.1±1.7) to (1.1±0.7),t=6.455,7.667,8.050,P=0.000,0.000,0.000;LSG group: (39.2±5.2) kg/m2 to (34.1±4.5) kg/m2 to (29.3±4.0) kg/m2 to (25.1±2.3) kg/m2,t=11.676,13.680,19.161,P=0.000,0.000,0.000;(8.0±2.9) mmol/L to (5.8±1.5) mmol/L to (5.1±0.9) mmol/L to (4.6±0.5) mmol/L,t=5.467,6.921,7.741,P=0.000,0.000,0.000;(29.1±25.2) μIU/ml to (16.4±10.6) μIU/ml to (8.8±5.5) μIU/ml to (5.5±2.0) μIU/ml,t=3.512,5.232,5.702,P=0.001,0.000,0.000;(7.7%±1.3%) to (6.3%±0.6%) to (5.8%±0.6%) to (5.2%±0.6%),t=8.001,10.106,11.922,P=0.000,0.000,0.000;(9.8±9.6) to (3.9±2.2) to (1.9±1.0) to (1.1±0.4),t=3.733,4.972,5.404,P=0.001,0.000,0.000] .There was no significant difference between the two groups in 1 year,3 year and 5 year post-operation (DM remission: 71% to 69%,89% to 80%,93% to 89%) (P>0.05). Conclusion LRYGB and LSG have the same long-term efficacy for T2DM patients.