腹腔镜手术治疗胆囊结石合并低体质量指数2型糖尿病

One stage laparoscopic therapy for gallbladder stones and type 2 diabetes of low body mass index

目的探讨腹腔镜手术同期治疗胆囊结石合并低体质量指数 （ body mass index, BMI）2型糖尿病 （ type 2 diabetes millitus, T2DM） 的临床疗效。方法回顾性分析2012年5月至2015年6月对75例胆囊结石合并T2DM患者行腹腔镜胆囊切除手术 （ laparoscopic cholecystectomy, LC ）同期对BMI≥28kg／m2的39例（A组）施行腹腔镜胃旁路术（laparoscopic Roux-en-Y gastric bypass,LRYGB）和BMI〈28ks／m2（B组）的36例行腹腔镜空回肠转流术（laparoscopic jejunoileal bypass,LJIB）的临床资料。结果75例患者均成功完成手术，无围手术期死亡，术后随访1年。2组患者治愈率分别为84．6％和88．9％，差异无统计学意义（X2=0．053，P〉0．05）。2组患者手术时间、术后住院时间、住院总费用、手术并发症等指标比较差异有统计学意义（分别t=-2．513，2．188，2．656 ,X2=6．351．均P〈0．05）。术后3、6、12个月A组患者BMI持续下降（分别t=3．251，2．348，4．581，均P〈0．05），而B组无明显变化（分别t=1．644，-0．045，2．124，均P〉0．05）。2组患者BMI比较，差异有统计学意义（F=2．32，P〈0．05）。结论胆囊结石合并T2DM患者施行LC的同时对低BMI患者选用LJIB手术，医疗费用低，治疗效果好。

Objective To explore the clinical efficacy of laparoscopic surgery for gallbladder stones with type 2 diabetes （T2DM） patients of low body mass index（BMI） . Methods The clinical data of 75 patients who received laparoscopic cholecystectomy and by-pass procedure for gallstones with T2DM from May 2012 to June 2015 were retrospectively analyzed. Laparoscopic Roux-ex-Y gastric bypass surgery was completed in 39 cases （ BMI≥28 kg/m2, group A） and laparoscopic jejunoileal bypass in 36 cases （ BMI 〈 28 kg/m2, group B ）. Results 75 patients were successfully completed surgery. There were no perioperative death, all patients were followed-up for 1 year after surgery. The cure rate were 84. 6% and 88. 9% respectively （X2 = 0. 053 ,P 〉 0.05 ）. Between the two groups operation time, postoperative length of hospital stay, total hospitalization expenses and surgical complications were statistically different （ respectively t = - 2. 513, 2. 188, 2. 656, X2 = 6.351, all P 〈 0.05）. Postoperative 3, 6 and 12 months BMI declines in group A patients （ respectively t = 3. 251, 2. 348, 4. 581, all P 〈 0. 05 ）, while there was no statistical difference in group B patients （ respectively t = 1. 644, - 0. 045, 2. 124, all P 〉 0.05 ） . BMI was statistically different between the two groups （ F = 2. 32, P 〈 0. 05 ）. Conclusions In patients with gallbladder stones and T2DM, LC and LJIB in low BMI patients can achieve exceUent results with low costs.