腹腔镜Roux-en-Y胃旁路术治疗不同肥胖程度2型糖尿病的疗效

Laparoscopic Roux-en-Y gastric bypass for type 2 diabetes mellitus patients in various obesity degree

目的 探讨腹腔镜Roux-en-Y胃旁路术治疗不同肥胖程度2型糖尿病（type 2 diabetesmellitus,T2DM）的手术效果.方法 回顾性分析2012年6月至2014年6月在北京大学人民医院接受腹腔镜Roux-en-Y胃旁路术治疗的T2DM患者36例,按BMI分成组1（13例,BMI≥32.5 kg/m2）和组2（23例,27.5 kg/m2≤BMI ＜32.5 kg/m2）,评价2组的手术疗效及并发症.结果 术后12个月,组1患者随着BMI由术前（37.7±3.6） kg/m2降到（29.1±3.5） kg/m2,空腹血糖和糖化血红蛋白（HbA1c）较术前改善[（7.8±1.6） mmol/L比（5.2±1.0） mmol/L,t=5.796,P=0.000;（7.3％±0.7％）比（6.1％±1.0％）,t=5.589,P=0.000].组2患者随着BMI由术前（30.0±1.6） kg/m2降到（25.8±3.2） kg/m2,空腹血糖和HbA1c亦较术前改善[（8.9±1.7） mmol/L比（6.1±1.5） mmol/L,t =6.577,P=0.000;（7.8％±1.8％）比（6.4％±1.0％）,t=4.257,P=0.000].2组术后的胰岛素抵抗指数较术前改善[组1：（10.8±5.8）比（2.8±4.1）,=6.415,P=0.000;组2：（6.5±5.3）比（1.8±1.4）,t=4.135;P =0.000],而胰岛素释放指数无变化[组1：（146±66）比（125±97）,t=1.007,P=0.334;组2：（60±33）比（62±41）,t=-0.155,P=0.878].2组术后12个月糖尿病完全缓解率和血糖、HbA1c的变化值相比差异均无统计学意义（均P＞0.05）.结论 腹腔镜Roux-en-Y胃旁路术治疗不同肥胖程度的T2DM患者均可取得满意疗效.

Objective To compare the effects of laparoscopic Roux-en-Y gastric bypass （LRYGB） for the treatment of type 2 diabetes mellitus （T2DM） patients in various obesity degree.Methods A total of 36 T2DM patients undergoing LRYGB were enrolled in this study in our hospital from June 2012 to June 2014.The patients were divided into BMI ≥ 32.5 kg/m2 group （n =13） and 27.5 kg/m2 ≤ BMI 〈 32.5 kg/m2 group （n =23） based on BMI.Results In group 1,following the degression of BMI from （37.7±3.6） kg/m2 to （29.1 ±3.5） kg/m2 at 12 months after surgery,fasting blood glucose of group 1 decreased from （7.8 ± 1.6）mmol/L to （5.2 ±1.0）mmol/L （t =5.796,P =0.000）,and HbA1c decreased from 7.3% ±0.7% to 6.1% ± 1.0% （t =5.589,P =0.000）;and following the degression of BMI from（30.0 ± 1.6） kg/m2 to （25.8 ± 3.2） kg/m2,fasting blood glucose of group 2 decreased from （8.9 ± 1.7） mmol/L to （6.1 ± 1.5） mmol/L （t =6.577,P =0.000）,and HbA 1 c decreased from 7.8 % ± 1.8% to 6.4% ± 1.0% （t =4.257,P =0.000）.Though Homa-IR of two groups was significantly improved after surgery （t =6.415,4.135;P =0.000,0.000）,there was no difference to Homa-β （t =1.007,-0.155;P =0.334,0.878）.Complete remission ratio of BMI ≥ 32.5 kg/m2 group was not significantly different with 27.5 kg/m2 ≤ BMI 〈 32.5 kg/m2 group.Conclusion LRYGB is effective for the treatment of type 2 diabetes patients despite preoperative various obesity degree.