腹腔镜改良回肠转位术治疗T2DM的临床疗效

Clinical effect of laparoscopic improved ileal bypass surgery for treatment of type 2 diabetes mellitus

目的探讨腹腔镜改良回肠转位术（1apamscopic impmved ileal bypass，uB）治疗T2DM的临床疗效。方法回顾性分析2012年5月至2015年7月南方医科大学附属咸阳市中心医院收治的52例行LIB的T2DM患者的临床资料，依据其BMl分为2组：A组（16例）BMI≥28kg／m^2；B组（36例）BMI〈28kg／m^2，均在腹腔镜下应用超声刀和切割吻合器等完成UB。收集52例术前及术后1年期内的空腹血糖（fasting blood glucose，FBG）、空腹C肽、糖化血红蛋白（gIycosy Iatedhemog Iobin，HbAlc）及BMI数值，评估12DM的转归。计数资料和率的比较采用X^2检验；正态分布的计量资料以z如表示，采用￡检验；重复测量数据采用重复测量方差分析。结果52例均顺利完成手术，无围手术期死亡。全部患者获术后1年随访。各组术前与术后12个月的FBG、HbAlc比较：A组（t=4．223，3．602，P〈0．05）；B组（t=4.356，5．613，P〈0．05），差异均有统计学意义。根据参照文献疗效评判标准，A组临床治愈13例、部分缓解2例、未愈1例，分别占本组病例的81．25％、12．5％、6．25％，B组临床治愈32例、部分缓解3例、未愈l例，分别占本组病例的88．9％、8．3％、2．8％，总治疗有效率达96．2％（50／52）。1年后2组间治愈率比较差异无统计学意义（X^2=O．053，P〉0．05）。2组术前与术后12个月BMI变化比较，A组（t=1．581，P〉0．05），B组（f=2．124，P〉0．05），差异均无统计学意义。结论UB治疗T2DM具有明显改善血糖代谢的作用，但对BMI影响不明显。非肥胖型T2DM是LIB的适应症，对肥胖型T2DM因减重效果不佳，选择应慎重。该术式创伤小，并发症少，易于操作，便于临床推广。

Objective To explore the clinical efficacy of laparoscopic improved ileal bypass （LIB）for treatment of type 2 diabetes mellitus（T2DM）. Methods The chnical data of 52 patients who received LIB for T2DM at the Center Hospital Xianyang City, Southern Medical University, from May. 2012 to Jul. 2015 were retrospec- tively analyzed. On the basis of their body mass index （BMI）, all cases were divided into two groups： group A （16 cases, BMI≥28 kg/m^2） and group B（36 cases, BMI 〈28 kg/m^2）. LIB surgery were complete by laparoscopic ultrasound knife and the cutting anastomat etc. Before and during one year after surgery fasting blood glucose（FBG）, fasting c-peptide, glycosylated hemoglobin （HbAlc） and BMI were detected to evaluate the outcome of T2DM.Count da- ta and comparison of rates were analyzed by chi-square test. Measurement data with normal distribution were presented as ~s and analyzed by the t test.Repeated measurement data were analyzed by the repeated measure- sanalysis of variance. Results All the 52 patients underwent successful LIB without perioperative death during the follow-up of 12 months. There were significant differences in FBG and HbAlc at admission and 12 months after surgery： group A 0=4.223, 3.602, P〈0.05）; group B （t=4.356, 5.613, P〈0.05）. With reference to the litera-turetll curative effect evaluation standard, 13 patients had complete remission, 2 patients had partial remission and 1 patient had non-remission in group A, accounting for 81.25%, 12.5%, and 6.25% respectively. For 36 patients in group B, 32 patients had complete remission, 3 patients had partial remission and 1 patient had non-remission, accounting for 88.9%, 8.3%, and 2.8% respectively. Total treatment effectiveness was 96.2% （50/52）. No sig- nificant differences was found between group A and group B at 12 months after surgery （X2=0.053, P〉O.05）. BMI at admission and 12 months after surgery had no significant differences in group A （t=1.581, P〉O.05）, nor group B（t=2.124, P〉O.05）. Conclusions LIB for T2DM improved the glucose metabolism significantly, with un- conspicuous influence for BMI and was indications for the non-obese T2DM. Due to the poor weight loss, LIB choose carefully in obese patients with T2DM. The therapy has small trauma, fewer complications, simple opera- tion skills and facilitated clinical promotion.