腹腔镜胃旁路术在2型糖尿病患者中的临床应用

Clinical application of laparoscopic Roux-en-Y gastric bypass in patients with type 2 diabetes mellitus

目的评价腹腔镜胃旁路术（laparoscopic Roux-en-Y gastric bypass，LRYGB）在2型糖尿病（type 2 diabetes，T2DM）患者中的临床应用效果。方法回顾性分析2013年12月至2015年12月于杭州市萧山区第一人民医院行腹腔镜胃路旁术患者83例，按体质量指数（BMI）不同分为低BMI组（25≤〈LBMI〈28）、中BMI指数组（28≤IBMI〈32）、高BMI指数组（HBMI≥32），比较3组T2DM患者腹腔镜胃旁路术的临床疗效及手术并发症，观察糖脂代谢指标变化情况，采用Cox风险回归模型评估影响T2DM患者手术并发症的因素。结果全组出现1例（HBMI组）术中转开腹手术，其余均顺利完成腹腔镜手术；手术时间、术中出血量和术后并发症与BMI指数成正比，且组间比较差异有统计学意义（P〈0．05）；全组术后副反应主要以轻度消化道反应为主。不同BMI组在术后1、3、6及12个月的空腹血糖（fasting blood—glucose，FBG）、餐后2h血糖、HbA1C和总胆固醇水平重复测量与组别交互作用差异均具有统计学意义（P〈0．05）；3组糖尿病缓解率分别为89．5％、89．3％和91．7％，组间比较差异无统计学意义（P〉0．05）。Cox多因素分析结果显示总胆固醇是影响术后并发症的独立预后因素（HR=0．47、95％CI=0．26-0．85、P=0．01）。结论LRYGB对T2DM患者安全性高，糖尿病临床疗效尚可，可有效改善糖脂类代谢，BMI的升高会提高LRYGB并发症的发生率，总胆固醇是术后并发症的独立预后因素。

Objective To evaluate the clinical effects of the laparoscopic Roux-en-Y gastric bypass （LRYGB） on patients with type 2 diabetes mellitus （T2DM）. Methods From Dec. 2013 to Dec. 2015, 83 cases with T2DM received LRYGB were enrolled to this study. They were divided into low body mass index group （LB- MI, 25 ≤BMI〈28）, intermediate body mass index group （IBMI, 28≤〈BMI〈32） and high body mass index group （HBMI, BMI≥33）. Meanwhile, the clinical effects and side-effects were evaluated among three groups. The factors of adverse effects were evaluated by Cox muhivariate analysis. Results Only one patient in HBMI was conversed to open surgery, all the others received LRYGB. The surgery time, intraoperative blood loss and complica tion were positively related to BMI, and the difference was statistically significant between the 3 groups（P〈0.05）. The main side-effect of LRYGB was gastrointestinal reaction. The level of fasting blood-glucose, postprandial 2 hours blood sugar, HbAlc and cholesterol total in three groups were lower than baseline （P〈0.05）, however, there was no significant difference among the three groups （P〉0.05）. The rate of clinical effects in three groups was 89.5%, 89,3%. and 91.7%. There was no significant difference among the three groups（P〉0.05）;In Cox multivariate analysis, cholesterol total and BMI were independent prognostic indicator for LRGB adverse. Conclusions LRYGB is a safe and effective method for patients with T2DM, which can effectively improve glucose and lipid metabolism. The increased BMI can increase the incidence of LRYGB complications. Total cholesterol is an independent prognostic indicator for the adverse of LRYGB.