腹腔镜Roux-en-Y胃旁路术在治疗肥胖型2型糖尿病中的应用价值

Application value of laparoscopic Roux-en-Y gastric bypass in treating obese 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)在治疗肥胖型2型糖尿病中的临床应用价值。方法回顾性分析2010年8月至2014年12月在中山市人民医院接受LRYGB治疗的42例肥胖型2型糖尿病患者的临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男28例,女14例;平均年龄(45±10)岁。术前和术后1周、1个月、3个月对所有患者的体质指数(body mass index,BMI)、空腹血糖(fasting plasma glucose,FPG)、餐后2小时血糖(2-hour postprandial blood glucose,2h PG)、血清C肽、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)和胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)进行检测。手术前后临床指标的比较采用t检验。结果 LRYGB后3个月,患者的平均BMI为(23.7±1.1)kg/m2,明显低于术前的(29.1±3.1)kg/m2(t=2.835,P<0.05);平均FPG水平为(6.1±0.5)mmol/L,明显低于术前的(12.5±3.9)mmol/L(t=3.861,P<0.05);平均HbA1c水平为(5.3±0.8)%,明显低于术前的(11.2±2.1)%(t=4.062,P<0.05);平均HOMA-IR为4.3±0.5,明显低于术前的7.2±0.7(t=3.575,P<0.05)。2型糖尿病的治疗有效率为100%(42/42),治愈率为90%(38/42)。结论 LRYGB治疗肥胖型2型糖尿病近期疗效显著,远期疗效仍有待于进一步观察。

Objective To investigate the clinical application value of laparoscopic Roux-en-Y gastric bypass(LRYGB) in treating obese type 2 diabetes mellitus. Methods Clinical data of 42 patients with obese type 2 diabetes mellitus undergoing LRYGB in the People's Hospital of Zhongshan from August 2010 to December 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 42 patients, 28 were males and 14 were females with an average age of(45±10) years old. Body mass index(BMI), fasting plasma glucose(FPG), 2-hour postprandial blood glucose(2h PG), C peptide and glycosylated hemoglobin A1c(HbA1c) and homeostatic mode assessment of insulin resistance(HOMA-IR) were tested before and 1 week, 1 month, 3 months after operation. Clinical data before and after operation were compared using t test. Results At 3 months after operation, the average BMI was(23.7±1.1) kg/m2, which was significantly lower than(29.1±3.1) kg/m2 before operation(t=2.835, P<0.05); the average FPG was(6.1±0.5) mmol/L, which was significantly lower than(12.5±3.9) mmol/L before operation(t=3.861, P<0.05); the average Hb A1 c was(5.3±0.8)%, which was significantly lower than(11.2±2.1)% before operation(t=4.062, P<0.05); the average HOMA-IR was 4.3±0.5, also significantly lower than 7.2±0.7(t=3.575, P<0.05). The effective ratio of the treatment of type 2 diabetes mellitus was 100%(42/42), and the cure rate was 90%(38/42). Conclusions LRYGB has an exact short-term effect on obese type 2 diabetes mellitus, but the long-term effect remains to be observed further.