腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病及其并发症的临床疗效观察

Clinical observation on therapeutic effect and complications of laparoscopic Roux-en-Y gastric bypass for type 2 diabetes mellitus

目的探讨腹腔镜Roux-en-Y胃旁路术(Laparoscopic Roux—en-Y gastric bypass,LRYGB)对2型糖尿病(type 2 diabetes mellitus,T2DM)及其并发症的长期临床疗效。方法回顾性分析我院收治的48例T2DM患者的临床资料。术后随访4年,分析术前及术后体重指数(BMI)、腰臀比(WHR)、糖脂代谢指标的变化。同时观察T2DM相关并发症的改善情况。结果48例手术均在腹腔镜下顺利完成,无一例中转开腹,随访期间,无死亡病例及严重手术并发症发生。48例T2DM患者的BMI及WHR在术后3个月、6个月、1年、2年、3年、4年均较术前显著下降,差异有统计学意义(P<0.05)。同时,糖代谢相关指标空腹血糖(FPG)、标准馒头餐后2h血糖(2h PG)、空腹C肽(FC-P)、糖化血红蛋白(HbA1c)于术后各时间点均较术前明显下降(P<0.05)。与术前比较,脂代谢相关指标TC、TG、HDL、LDL于术后各时间点均较术前明显改善(P<0.05)。48例接受LRYGB的T2DM患者有效率达100%。结论腹腔镜Roux-en-Y胃旁路术是治疗2型糖尿病的一种安全有效的手术方式,完善的术前评估、围手术期规范化的管理及长期随访是保证手术疗效的关键。

Objective To investigate the long-term clinical effect of Laparoscopic Roux-en-Y gastric bypass（LRYGB） in treatment type 2 diabetes mellitus （T2DM）and its complications. Methods The clinical data of 48 patients with T2DM who underwent LRYGB in our hospital were analyzed retro- spectively. The patients were followed up for 4 years. Preoperative and postoperative data including body mass index （ BMI）, waist-hip ratio （ WHR）, and glucose lipid metabolism index were compared. Mean- while,T2DM-rdated complications were also observed. Results All procedures were completed laparoscopically. No mortality and significant surgical complications occurred. The comparison of preoperative and postoperative data demonstrated that BMI and WHR were significantly decreased at the 3rd month ,6th month, 1 st year,2nd year, 3rdyear, and 4th year（ P 〈 0.05 ）. Meanwhile, compared with the levels before operation,FPG,2h-PG,FC-P, and HbAlc were decreased at all time points after operation（P 〈 0.05）. Moreover, TC, TG, HDL and LDL were significantly improvedpostoperatively （ P 〈 0.05 ）. At last, the effective rate was 100%. Conclusion Laparoscopic Roux-en-Y gastric bypass in obese patients with T2DM is a safe and effective treatment method. An overall preoperative evaluation, standard perioperative management and follow-up studies are critical to ensure the efficacy of the operation.