腹腔镜胃旁路术和胃袖状切除术治疗肥胖合并2型糖尿病的疗效比较

Comparison between laparoscopic gastric bypass and sleeve gastrectomy in treatment of obesity patients with type 2 diabetes mellitus

目的:比较腹腔镜胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)和腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)治疗肥胖合并2型糖尿病(type 2 diabetes mellitus,T2DM)的疗效。方法:选择21例肥胖合并T2DM行手术治疗的患者,按术式分为LRYGB组(n=11)和LSG组(n=10),分析两组患者手术前和手术后1、6、12月内糖代谢指标变化;SF-36生命质量量表分析两组患者术后生理健康和精神健康;调查患者术后生活满意度。结果:与术前比较,两组患者手术后1,6,12月空腹血糖、餐后2 h血糖、糖化血红蛋白、胰岛素抵抗指数、空腹C肽、体质量指数水平均明显下降(P均<0.05),而同一时间点两组患者血糖指标间的差异无统计学意义(P>0.05);LRYGB组术后患者生理功能、总体健康、活力、情感职能和精神健康生较LSG组明显改善(P<0.05),术后12个月生活满意度(90.9%)明显高于LSG组(80.0%,P<0.05)。结论:LRYGB和LSG均是治疗肥胖合并T2DM的可靠方法,但前者患者生活质量优于后者。

Objective： To compare the treatment of obesity patients with type 2 diabetes mellitus （T2DM） by laparoscopic Roux-en-Y gastric bypass（LRYGB） and laparoscopic sleeve gastrectomy （LSG）. Methods： Twenty-one obesity patients with T2DM who underwent bariatric surgery were selected in the study, and divided into LRYGB group（n = 11） and LSG group（n = 10）. The changes of glucose metabo- lism index in two groups were analyzed before and after operation in 1,6, 12 months. SF-36 scale was used to observe the physical health and mental health of patients after operation. The life satisfactions of patients after operation were also investigated. Results： Compared with pre-operation, fasting plasma gluose, 2 h postprandial blood glucose （ 2hPG）, glycosylated hemoglobin （ HbA1c ）, insulin resistance index （ HOMA- IR）, fasting C-peptide and body mass index（BMI）were significantly decreased at the 1st, 6th and 12th month after surgery in both LRYGB and LGS groups （ P 〈 0.05 ） ; but there were no significant differences between the two groups at the same time（P 〉 0.05 ）. SF-36 scale showed that patients physiological function, overall health, energy, emotional function and mental health in LRYGB group were greatly improved than in LSG group（ P 〈 0.05 ）. The quality of life in LRYGB group was higher than LSG group （90.9% vs 80.0%, P 〈 0.05 ）. Conclusion： LRYGB and LSG were effective to patients with T2DM, but the life quality of LRYGB was better than LSG.