为什么胃袖状切除术治疗2型糖尿病是比胃旁路术更好的策略

Why sleeve gastrectomy is a better strategy than Roux-en-Ygastric bypass for type-2 diabetes mellitus

2型糖尿病是累及全世界4亿多人的慢性疾病。与内科治疗比较，手术是唯一可能治愈的方法。大量临床研究结果显示：胃袖状切除术对于降低体质量、控制血糖有肯定疗效．其控制血糖效果与胃旁路术比较，差异无统计学意义。胃袖状切除术通常可以获得满意的临床疗效，一旦糖尿病控制效果欠佳或术后复发，可以采用多种二期手术方式，包括回肠问置术、十二指肠空肠转流术、空回肠侧侧吻合术等多种选择。二期胃旁路术不仅破坏了残留的袖状胃，切除了用于胃排空的调节瓣，还旷置了十二指肠，并非最佳方案。笔者强烈推荐胃袖状切除术作为一期手术，若糖尿病治疗无效或者复发，则增加有关肠道手术。

Type-2 diabetes mellitus is a chronic disease that affects now 417 millions worldwide. Surgery is now the only efficacious treatment, when compared to best medical treatment. Sleeve gastrectomy, the most frequent bariatric/ metabolic surgery performed in the world, is associated with significant improvement in glycemie status in long-term. There are no real significant differences between the sleeve gastrectomy and gastric bypass at 5 years, nor in weight loss, nor in resolution of type-2 diabetes mellitus as measured by fasting blood glucose. The author strongly advocates sleeve gastrectomy as a first intention. If the patients fail to have substantial effect on their diabetes or if recidivism is seen, then the second stage intestinal procedures can be added, which include single anastomosis duodeno-ileostomy, duodenal switch, ileal inter- position, duodeno-jejunal bypass, amongst others, all preserving the sleeve and pylorus. Conversion from sleeve to Roux-en-Y gastric bypass may be problematic, increasing risks of peptic ulcers, dumping syndromes, bowel obstructions, micro-nutrients deficiencies and it may not be strong enough to reverse diabetes.Because of the loss of pylorus, the risk of glycemic deregulations with severe hypoglycemia or delayed hyperglycemia syndromes would possibly appear.