腹腔镜袖状胃切除术治疗肥胖性2型糖尿病的疗效分析

Efficacy analysis of laparoscopic sleeve gastrectomy in treatment of obesity with type 2 diabetes mellitus

目的 探讨腹腔镜袖状胃切除术（LSG）对肥胖性2型糖尿病（T2DM）的治疗效果及手术安全性.方法 回顾性分析2010年5月至2012年2月在第二军医大学附属长海医院微创外科接受LSG的32例肥胖性T2DM患者的临床资料.测量并计算患者术后1、3、6和12月的体质量指标[体质量、腰围、体质量指数（BMI）及多余体质量减少率（EWL）]、血糖指标[糖化血红蛋白（HbA1c）、空腹血糖（FPG）和胰岛素抵抗指数（HOMA-IR）]和血脂指标[血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇（LDL-C）及高密度脂蛋白胆固醇（HDL-C）]水平,并与术前进行比较.结果 本组患者除1例因腹腔广泛粘连中转开腹,其余均在腹腔镜下完成手术.手术时间（115.0±19.6） min,术中出血量（69.0±29.7） ml.全组无手术死亡患者,无吻合口瘘、切口感染及腹腔脏器损伤发生.与术前相比,术后1、3、6和12月患者体质量、腰围及BMI均明显降低（P＜0.05）,且随时间呈下降趋势;而EWL呈明显上升趋势（P＜0.05）;随访12月,无体质量过低现象.从术后1月开始,患者HbA1c、FPG和HOMA-IR较术前明显降低（P＜0.05）;HbA1c和FPG分别从术后12月和术后6月处于基本稳定水平（P＞0.05）;术后3月有28例患者血糖已恢复正常.随访12月,T2DM临床完全缓解率87.5％（28/32）,部分缓解率12.5％（4/32）.血清总胆固醇、甘油三酯及LDL-C水平较术前明显降低（P＜0.05）.结论 对于肥胖性T2DM的患者,LSG是一种安全有效的手术方式.

Objective To investigate the efficacy and safety of laparoscopic sleeve gastrectomy （LSG） for the treatment of obesity with type 2 diabetes mellitus （T2DM）.Methods Clinical data of 32 obesity patients with T2DM patients undergoing LSG from May 2010 to February 2012 in our department were retrospectively analyzed.Their body weight indexes （body weight,waist circumference,BMI,EWL）,blood glucose indexes [glycosylated hemoglobin （HbA1c）,fasting plasma glucose （FPG）,insulin resistance index （HOMA-IR）],and blood lipid indexes [total cholesterol,triglyceride,low density lipoprotein cholesterol （LDL-C）,high density lipoprotein cholesterol （HDL-C）] were measured 1,3,6,12 months after operation and compared with preoperative levels.Improvement in complications was observed.Results All the patients completed operation under laparoscopy except 1 case because of abdominal cavity adhesion.The average operative time was （115.0±19.6） min,and the average blood loss （69.0 ±29.7） ml.No operative death,anastomotic leakage,or surgical site infection were found.The body weight,waist circumference and BMI at 1,3,6,and 12 months after surgery were significantly lower （all P〈0.05） showing a decreasing trend over time.EWL showed significant increasing trend （P〈0.05）.During 12 months of follow-up,no over-low weight was observed.From 1 month after surgery,HbA1c,FPG and HOMA-IR decreased significantly （P〈0.05）.HbA1c and FPG maintained stable level at 12 and 6 months after operation respectively.FPG of 28 patients returned to normal 3 months after operation.Clinical complete remission rate of T2DM was 87.5%（28/32）,and clinical partial remission rate was 12.5%（4/32） at the 12-month follow-up.Serum total cholesterol,triglyceride and LDL-C decreased obviously after surgery （P〈0.05）.Conclusion LSG procedure is a safe and effective surgical method in treatment of obesity with T2DM.