腹腔镜袖状胃切除术治疗2型糖尿病的疗效

Laparoscopic sleeve gastrectomy for patients with type 2 diabetes mellitus

目的 探讨腹腔镜袖状胃切除术治疗2型糖尿病的疗效.方法 选择2013年6月至2017年6月期间在北京世纪坛医院手术治疗因肥胖、同时患有T2DM的39例患者,分别测定患者术前及术后1、6个月空腹血糖、糖化血红蛋白、C肽、空腹胰岛素、胰高血糖素样肽1及BMI,观察腹腔镜袖状胃切除术的治疗效果.结果 39例T2DM患者均成功实施腹腔镜袖状胃切除术.术后6个月患者的空腹血糖、糖化血红蛋白、C肽、空腹胰岛素和BMI均较术前有所下降[(6.4±1.2) mmoL/L比(9.6±2.3)mmol/L,t=9.455,P=0.000;(6.0%±0.7%)比(7.5%±1.0%),t=10.538,P=0.000;(2.7±2.2) ng/ml比(4.0±2.6) ng/ml,t=3.491,P=0.001;[(9.2±6.3) μlU/L比(15.5±11.1) μIU/L,t=4.902,P=0.000];(32.0±6.1)kg/m2比(41.0±7.5) kg/m2,t=10.826,P =0.000],而平均胰高血糖素样肽1较术前有所升高[(4.0±2.1)pmol/L比(3.1±2.2) pmol/L,t=-4.242,P=0.000].术后6个月时32例糖尿病得到完全缓解,5例糖尿病部分缓解,2例无效.结论 腹腔镜袖状胃切除术在减轻体重的同时对2型糖尿病也有明显的治疗效果.

Objectives To investigate the efficacy of laparoscopic sleeve gastrectomy ( LSG ) for patients of type 2 diabetes mellitus ( T2DM ). Methods Between Jun 2013 and Jun 2017, 39 T2DM patients were enrolled in this study and underwent LSG. The clinical data of all patients were collected. The fasting plasma glucose ( FPG ), glycosylated hemoglobin ( HbA 1 c ), C-peptide , fasting insulin ( FINS ), glucagon-like peptide-1 ( GLP-1 ) as well as BMI of all patients were measured before and at 1 , 6 months after surgery. Results All patients underwent LSG surgery successfully. The mean levels of FPG, HbAlc, C-peptide, FINS and BMI of all patients decreased at 6 months after surgery respectively compared to those before surgery [(6. 4 ± 1.2 ) mmol/L vs.(9. 6 ± 2. 3 ) mmol/L, t = 9. 455 , P = 0. 000;(6. 0 ± 0. 7)% vs.(7.5 ±1.0)%,t== 10.538, P = 0.000;(2.7 ± 2. 2) ng/ml vs.(4. 0 ± 2. 6) ng/ml,t= 3.491, P = 0. 001;(9.2±6.3)μIU/L vs.(15.5 ±11. 1)μIU/L,t=4.902, P = 0. 000;(32. 0 ±6. 1) kg/m2 vs.(41.0 ± 7. 5 ) kg/m2, t = 10. 826, P = 0. 000 ], however the mean GLP-1 of all patients increased after surgery compared to that before surgery [(4. 0 ± 2. 1 ) pmol/L vs.(3. 1 ± 2. 2) pmol/L,/=-4. 242, P = 0. 000 ]. At 6 months after surgery, 32 patients achieved complete remission of T2DM , 5 patients gained partial remission of T2DM and 2 patients got no remission of T2DM. Conclusions LSG is effective for obesity patients as well as patients suffering from T2DM.