腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病的疗效及指标相关性分析

Curative effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus and correlation analysis

目的探讨腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病的早中期疗效及手术后疗效预判的预测指标。方法回顾性分析2010年10月至2012年10月因2型糖尿病在中南大学湘雅三医院接受腹腔镜胃旁路术治疗的78例患者的临床资料。其中男52例,女26例。所有患者在气管插管全麻下行腹腔镜胃旁路术。术后观察体重、血糖、血脂等相关指标,比较术后不同时期各测量指标的差异及初步探讨术后疗效的预测指标。结果 78例患者术后2型糖尿病完全缓解34例,44例胰岛素或药物使用量明显下降。BMI、腰臀比、胆固醇脂、空腹血糖、2小时血糖、空腹C肽(FCp)、HbA1c和胰岛素抵抗指数(HOMA-IR)均较术前明显改善(P<0.05)。BMI、甘油三酯、餐后2h胰岛素分泌量、FCp、2hCp、HOMA-IR对手术治疗2型糖尿病的疗效有相关性。结论腹腔镜胃旁路术治疗T2DM的临床疗效确切,BMI、胰岛分泌功能、HOMA-IR可推荐作为手术疗效预判的预测指标。

Objective To investigate the early and middle stage outcomes of laparoscopic Roux-en-Y gastric bypass surgery in the treatment of type 2 diabetes mellitus（T2DM） and the predictors of postoperative effect.Methods Clinical and follow-up data of 78 patients undergoing laparoscopic Roux-en-Y gastric bypass surgery in Xiangya Third Hospital from October 2010 to October 2012 were retrospectively studied. Among the 78 patients, 52 were males and 26 were females. All the patients received laparoscopic Roux-en-Y gastric bypass under intubation anesthesia. Postoperative weight, blood glucose, blood lipid and correlative indexes were observed and compared with the data before surgery to analyse the predictors of curative effects.Results Among the 78 patients, 34 cases had complete remission of T2DM, 44 cases obviously decreased the usage of insulin and correlative medicine postoperatively. BMI, waist hip rate, cholesterol, FPG, 2hPG, fasting c-peptide, 2hCp/FCp, HbA1c and HOMA-IR improved comparing with the data before surgery （P〈0.05）. BMI、TG、2hINS、FCp、2hCp、HOMA-IR was associated with the curative effect of surgery in the treatment of T2DM.Conclusions The curative effect of laparoscopic Roux-en-Y gastric bypass in the treatment of T2DM was confirmed. BMI, insulin secretion function and HOMA-IR can be recommended as the predictors of surgical outcomes.