腹腔镜胃旁路术治疗低体质量指数2型糖尿病的疗效与安全性分析

Efficacy and safety analysis of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus with low body mass index

目的探讨腹腔镜Roux-en-Y胃旁路术(LRYGB)治疗低体质量指数2型糖尿病的疗效及安全性。方法回顾性分析2010年5月至2017年5月在陆军军医大学附属大坪医院接受LRYGB治疗的81例经内科治疗难以控制血糖的2型糖尿病(T2DM)患者的临床随访资料。以体质量指数(BMI)为27.5 kg/m^2作为分组截点,将患者分为高BMI组(BMI>27.5 kg/m^2)和低BMI组(BMI≤27.5 kg/m^2)。高BMI组53例,男31例,女22例,平均年龄(41.4±11.3)岁;低BMI组28例,男13例,女15例,平均年龄(48.5±7.5)岁。所有患者均签署知情同意书,符合医学伦理学规定。比较术后1、3、6、12、24、36个月两组患者体重、BMI、腰围、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)等指标。结果术后两组患者FPG、Hb A1c、BMI、腰围等水平随时间推移呈下降趋势,并在术后6个月开始呈稳定趋势,与术前相比差异有统计学意义(P<0.05)。术后24月,低BMI组患者FPG水平较术前明显降低(t=2.226,P<0.05),与高BMI组比较差异无统计学意义(t=-1.21,P>0.05);低BMI组患者Hb A1c水平较术前明显降低(t=2.513,P<0.05),与高BMI组比较差异无统计学意义(t=-0.181,P>0.05)。两组患者TC、TG、LDL-C水平较术前有所下降,但与术前比较差异无统计学意义(P>0.05);两组患者HDL-C水平较术前有所上升,但与术前比较差异无统计学意义(P>0.05)。两组患者糖脂代谢指标在术后各随访时间点相比无统计学意义(P>0.05)。两组患者术后1年T2DM临床完全缓解率及部分缓解率比较差异无统计学意义(P>0.05)。术后患者近远期死亡率为0,并发症发生率为8.6%。结论腹腔镜Roux-en-Y胃旁路术能明显降低低体质量指数2型糖尿病患者的体重,改善糖脂代谢情况,且手术的近远期安全性也是可靠的。

Objective To investigate the efficacy and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of type2diabetes mellitus(T2DM)with low body mass index(BMI).Methods clinical data of81patients with T2DM undergoing laparoscopic Roux-en-Y gastric bypass in the Daping hospital of Army Medical University between May2010and May2017were studied retrospectively.According to their BMI,these patients were divided into the higher BMI group(BMI>27.5kg/m2)and lower BMI group(BMI≤27.5kg/m2).53patients were included into the BMI>27.5kg/m2group,among them,31were males and22were females with an average age of(41.4±11.3)years old.28patients were included into the BMI≤27.5kg/m2group,among them,13were males and15were females with an average age of(48.5±7.5)years old.The informed consents of all patients were obtained and the local ethical committee approval had been received.BMI,Waist,Fasting plasma glucose(FPG),glycosylated hemoglobin A1c(HbA1c),total cholesterol,triglyceride,high density lipoprotein cholesterol and low density lipoprotein cholesterol after1,3,6,12,24,36months were compared.Results The FPG,HbA1c,BMI and waist declined over time after surgery in both groups,and maintained stable6months after surgery,which were significantly lower than the preoperative(P<0.05).At24months after surgery,the average FPG level of the BMI≤27.5kg/m2group was significantly lower than that before surgery(t=2.226,P<0.05),but had no statistical difference with that of the BMI>27.5kg/m2group(t=-1.21,P>0.05);the average HbA1c level of the BMI≤27.5kg/m2group was significantly lower than that before surgery(t=2.513,P<0.05),but had no statistical difference with that of the BMI>27.5kg/m2group(t=-0.181,P>0.05).Although the average TC,TG,LDL-C level of two groups showed a decreasing trend,they had no statistical difference with the preoperative(P>0.05).The average HDL-C level of two groups showed an increasing trend,but had no statistical difference with the preoperative(P>0.05).There were no significant difference in glucose and lipid metabolism at any point in both groups.The differences of clinical complete remission rate and partial remission rate of T2DM among two groups were not statistically significant(P>0.05).There were no early and late mortality,and seven patients(8.6%)developed early or late complications.Conclusions Laparoscopic Roux-en-Y gastric bypass can significantly reduce weight and improve glucose and lipid metabolism for T2DM with low BMI,and the short-term and long-term postoperative safety is reliable.