腹腔镜胃旁路术与药物治疗肥胖合并2型糖尿病疗效比较分析

Outcomes of laparoscopic Roux-en-Y gastric bypass and medical therapy in obese patients with type 2 diabetes

目的观察评价腹腔镜胃旁路术(LRYGB)及药物治疗对肥胖合并2型糖尿病的治疗效果。方法采用前瞻性随机对照方法分析2010—2013年天津市南开医院(107例)和天津医科大学代谢病医院(73例)共180例肥胖病合并2型糖尿病病人临床资料,随机分为LRYGB组(施行LRYGB,90例)和药物组(药物治疗,90例),随访期限为3年,观察分析病人的体重指数(BMI)、多余体重减少百分比(%EWL)及糖尿病相关指标变化。结果 LRYGB组完成随访87例(96.7%),药物组完成随访88例(97.8%)。LRYGB组手术顺利,%EWL为(66.0±7.3)%,BMI从术前的39.5±3.7降至29.3±6.2,糖化血红蛋白(HbA1c)从术前的(8.6±3.0)%降至(6.8±2.0)%,空腹血糖(FBG)从术前的(9.6±2.8)mmol/L降至(7.2±3.5)mmol/L;药物组%EWL为(3.8±6.2)%,BMI从38.8±6.0降至38.2±6.7,HbA1c从(9.0±3.6)%降至(8.5±3.8)%,FBG从(9.7±3.3)mmol/L降至(9.3±3.1)mmol/L。两组减重和糖尿病各关键指标差异均有统计学意义(P<0.05)。结论 LRYGB对肥胖合并2型糖尿病的短期疗效可靠,且优于药物治疗,糖尿病缓解率为64.4%,未出现严重并发症。

Objective To observe and evaluate therapeutic results of laparoscopic Roux-en-Y gastric bypass （LRYGB） and medical therapy for the patients of obesity with type 2 diabetes mellitus （T2DM）. Methods A randomized controlled trial was conducted among the 180 obese patients with T2DM who were selected from Tianjin Nankai Hospital （107 cases） and Tianjin Medical University Metabolic Diseases Hospital （73 cases） from 2010 to 2013. The 180 cases were randomly divided into LRYGB group and medical therapy group （90 cases per group）. The 3 years follow-up outcomes of BMI, %EWL and data about diabetes were analyzed. Results There were 87 （96.7%） and 88 （97.8%） cases who were observed and followed up for 3 years in each group. The operations were successful in LRYGB group. After 3-year follow up, in the LRYGB group, the BMI changed from 39.5±3.7 to 29.3±6.2; %EWL was （66.0±7.3） %; the glycosylated hemoglobin （HbAlc）changed from （8.6±3.0） % to （6.8±2.0） %; the fast blood glucose （FBG） changed from （9.6±2.8） mmol/L to （7.2±3.5） mmol/L. In medical group, BMI changed from 38.8±6.0 to 38.2±6.7; %EWL was （3.8±6.2） %; the HbAlc changed from （9.0±3.6）% to （8.5±3.8）%; the FBG changed from （9.7±3.3）mmol/L to （9.3±3.1） mmol/L. The differences of outcomes regarding obesity and diabetes were significant statistically （P〈0.05）. Conclusion The short term effect of LRYGB in obesity and T2DM is reliable and superior to the medical therapy. Diabetes remission rate of LRYGB is 64.4%, without any severe complications. LRYGB is an effective method which can be used to treat the Chinese obese patients with T2DM.