手术治疗低体质量指数2型糖尿病患者的临床疗效

Efficacy of two bariatric surgeries in type 2 diabetic patients with a body mass index of 25-27.5

目的探讨胃旁路术与袖状胃切除十二指肠空肠旁路术(SADJB-SG)对25≤体质量指数<27.5(低体质量指数)的2型糖尿病患者的临床疗效。方法回顾性分析2013年8月~2015年8月广州军区广州总医院甲乳糖尿病外科31例低体质量指数的2型糖尿病患者临床资料,其中17例行胃旁路术,14例行SADJB-SG,分析其术后1年物理、糖代谢及胰岛功能指标变化。结果 31例低体质量指数的2型糖尿病患者术后随访1年:胃旁路术组术后体质量、体质量指数、糖化血红蛋白、空腹血糖、餐后2 h血糖、C肽、空腹胰岛素、餐后2 h胰岛素较术前均有明显改善(P<0.05);SADJB-SG组术后体质量、体质量指数、糖化血红蛋白、空腹血糖、餐后2 h血糖、空腹胰岛素较术前均有明显改善(P<0.05);两组比较,术后体质量、体质量指数、糖化血红蛋白、空腹血糖、餐后2 h血糖、C肽、餐后2 h C肽、餐后2 h胰岛素等代谢指标改善程度均未见明显差异(P>0.05)。SADJB-SG术后胃肠吻合口炎、倾倒综合征较胃旁路术减少。结论 SADJB-SG治疗低体质量指数的2型糖尿病疗效与胃旁路术基本类似,但SADJB-SG胃肠吻合口炎、倾倒综合征的发生率低,可能更适合低体质量指数的2型糖尿病患者,更多研究需进一步随访。

Objective To evaluate the therapeutic effects of laparoscopic Roux-en-Y gastric bypass(LRYGB) and laparoscopic duodenal-jejunal bypass with sleeve gastrectomy(SADJB-SG) in patients with type 2 diabetes mellitus and a low body mass index(BMI) of 25-27.5. Methods Thirty-one type 2 diabetic patients with a BMI of 25-27.5 underwent bariatric surgeries in the General Hospital of Guangzhou Military Command between August, 2013 and August, 2015. The patients receiving LRYGB(17 cases) and SADJB-SG(14 cases) were compared for physical indexes, glucose metabolism and of pancreatic islet function at1 year after the surgeries. Results No mortality occurred in the patients after the operations. At 1 year after the operation, the patients in LRYGB group showed significant improvements in body weight, BMI, glycated hemoglobin(Hb A1c), fasting plasma glucose(FPG), oral glucose tolerance test 2 h(OGTT2h), C-peptide, fasting insulin(FINS), and postprandial 2 hour insulin(2 h PINS)(P<0.05); in SADJB-SG group, significant improvements were observed in the body weigh, BMI, Hb A1 c, FPG,OGTT2 h, and FINS after the operation(P<0.05). The postoperative improvements in body weigh, BMI, Hb A1 c, FPG, OGTT2 h,C-peptide, and 2h PINS were comparable between SADJB-SG group and LRYGB group(P>0.05), but the incidence of postoperative anastomotic ulcer was lower in SADJB-SG group. Conclusion SADJB-SG and LRYGB produce similar therapeutic effects in type 2 diabetic patients with a low BMI, but SADJB-SG is associated with a low incidence of postoperative complications and is therefore more suitable in such patients.