袖状胃切除术与Roux-en-Y胃转流术治疗肥胖及2型糖尿病疗效的Meta分析

A META-ANALYSIS OF SLEEVE GASTRECTOMY VERSUS ROUX-EN-Y GASTRIC BYPASS FOR MORBID OBESITY AND DIABETES MELLITUS

目的：系统评价袖状胃切除术与Roux-en-Y胃转流术治疗肥胖及2型糖尿病疗效。方法：以＂bariatric surgery＂、＂T2DM＂、＂gastric bypass＂、＂sleeve gastrectomy＂、＂RCT＂、＂代谢手术＂、＂减重手术＂、＂糖尿病＂、＂胃转流术＂、＂胃旁路术＂、＂袖状胃切除术＂、＂随机对照＂等为检索词分别检索Pub Med、EMBASE、Cochrane Library、CNKI和万方数据库。检索日期为各数据库建库至2014-10-01。最终纳入袖状胃切除术与Roux-en-Y胃转流术治疗肥胖及2型糖尿病相关文献共9篇进行Meta分析。结果：共纳入病例713例,其中袖状胃切除术组315例,Roux-en-Y胃转流术组398例。Meta分析结果：与Roux-en-Y胃转流术相比,袖状胃切除术在术后2型糖尿病缓解（RR=0.85,95%CI：0.67-1.09,P〉0.05）,术后多余体重降低百分比（MD=0.29,95%CI：-6.51-7.10,P〉0.05）和术后体重指数（body mass index,BMI）变化（MD=-0.32,95%CI：-1.16-0.51,P〉0.05）方面效果相当;在术后并发症方面,袖状胃切除术优于Roux-en-Y胃转流术（RR=0.55,95%CI：0.33-0.94,P〈0.05）。结论：袖状胃切除术在对肥胖及2型糖尿病的治疗上可作为优选术式。

Objective：To review the effect of sleeve gastrectomy （ SG ） and Roux-en-Y gastric bypass（ RYGB） for the treatment of obesity and type 2 diabetes. Methods：Electronic literature search was performed on PubMed,EMBASE,Cochrane Library,CNKI and Wanfang database from inception to October 1 ,2014 . The following medical subject headings （ MeSH ） and keywords were used：“bariatric surgery”、“T2 DM”、“gastric bypass”、“sleeve gastrectomy”、“RCT”. Finally we got 9 literatures focused on the comparison of the effect of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of obesity and type 2 diabetes to review. Results：Among all the 9 included studies,a total of 713 cases were reported,including 315 patients in the sleeve gastrectomy group and 398 patients in the Roux-en-Y gastric bypass group. The results of the Meta analysis showed that there were no significant difference in the remission rate of T2DM（RR=0. 85,95%CI：0. 67 ~1. 09,P〉0. 05）,no significant difference in the percentage excess weight loss （ MD=0 . 29 , 95%CI：-6 . 51 ~7 . 10 , P〉0 . 05 ） , no significant difference in the change of BMI（MD=-0. 32,95%CI：-1. 16~0. 51,P〉0. 05）. But in the incidence of complications,the sleeve gastrectomy showed significant advantage（RR=0. 55,95%CI：0. 33~0. 94,P〈0. 05）. Conclusion：The sleeve gastrectomy could be a better way for the treatment of obesity and type 2 diabetes.