我国2型糖尿病的外科治疗术式探讨

Exploration of surgical procedures in the treatment of type 2 diabetes mellitus in China

由于我国的2型糖尿病患者中位体质量指数（BMI）只有24 kg/m2以及我国糖尿病患者存在的饮食差异性,使得目前国内尚缺少充足的减重手术数据和指南,因此,我国医生在国际上公认的术式之外,进行了手术治疗2型糖尿病的术式探索.2011年国际糖尿病联盟（IDF）治疗2型糖尿病的推荐术式主要有：胃旁路手术（GBP）、袖状胃切除术（SG）、胆胰转流手术（BPD）、十二指肠转位术（DS）和可调节胃束带术（AGB）.本文重点分析我国外科医生的进展探索性术式,主要包括：袖状胃切除术加十二指肠空肠旁路术,十二指肠空肠旁路术,袖状胃切除加空回肠旁路术,袖状胃切除加回肠间置术,单纯回肠间置术及空、回肠短路术,胃大弯折叠术以及折叠术加胃束带术,以及其他在内镜下完成的减重术式.每种术式均各有特点,但哪种术式更为适合国内2型糖尿病患者,尚需临床的长期随访及大样本的多中心研究的开展,相信在科学规范前提下,我国的外科医生会摸索出最适合本国2型糖尿病患者的手术方式.

The median body mass index （BMI） of patients with type 2 diabetes mellitus （T2DM） in China is only 24 kg/m2 and diabetic diet in China is different from that in the Western countries.Currently there are no sufficient weight loss surgery data and guidance in China.Therefore,aside from the internationally recognized surgical procedures,Chinese surgeons have been trying to find other suitable procedures for T2DM.In 2011,operations for treatment of T2DM recommended by the International Diabetes Federation （IDF） are as follow：gastric bypass surgery （GBP）,sleeve gastrectomy （SG）,bile pancreatic surgery （BPD）,duodenal inversion technique （DS） and the adjustable gastric band surgery （AGB）.At present,the main exploratory surgery procedures in China include：sleeve gastrectomy and duodenaljejual bypass,duodenaljejual bypass,sleeve gastrectomy and jejualileal bypass,sleeve gastrectomy and ileal interposition,ileal interposition,jejunalileal bypass,gastric folding technique,gastric folding and banding,and other weight loss surgery under endoscopy.Each operation has different characteristics,but the optimal surgery for patients with T2DM still needs long term follow-up and large sample of multicenter clinical research.We believe that under the scientific standardization,surgeons in China will develop the most suitable procedures for patients with T2DM.