腹腔镜胃旁路术治疗非肥胖2型糖尿病的疗效与安全性分析

Clinical effect and safety analysis of laparoscopic Roux-en-Y gastric bypass for the treatment of non-obese type 2 diabetes mellitus

目的探讨腹腔镜Roux-en-Y胃旁路术(LRYGB)治疗非肥胖2型糖尿病(T2DM的疗效及安全性。方法收集2016年1月至2017年6月在贵州省人民医院普外科行LRYGB的28例T2DM患者的临床资料。根据术前体质量指数(BMI)将患者分为非肥胖组(BMI≤27.5 kg/m^2)11例和肥胖组(BMI>27.5 kg/m^2)17例。分析两组患者术前和术后3、6、9、12个月空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、空腹C肽(FCp)、空腹胰岛素(FIns)的变化及并发症情况。结果两组患者均顺利完成手术,手术时间及出血量比较差异无统计学意义(t=0.642、0.871,P=0.526、0.392),术后均无严重并发症发生,术后BMI、FPG、Hb A1c、FCp、FIns随着时间的推移均呈持续下降的趋势,且明显低于术前水平(P<0.05)。非肥胖组患者BMI在各时间点均低于肥胖组患者(P<0.05),术后12个月时非肥胖组的FCp水平显著低于肥胖组(t=0.711,P<0.05)。非肥胖组和肥胖组术后1年T2DM完全缓解率分别为72.7%(8/11)和82.4%(14/17),差异无统计学意义(χ^2=0.368,P=0.544)。结论 LRYGB能明显降低非肥胖型T2DM患者的体质量,并改善糖代谢情况,且手术安全。

Objective To investigate the clinical effect and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of non-obese type 2 diabetesmellitus(T2DM). Methods The clinical data of 28 patients with T2DM performed LRYGB surgery between January 2016 and June 2017 in Guizhou Provincial People’s Hospital were analyzed. According to body mass index(BMI), these patients were divided into the non-obese group(11 cases, BMI≤27.5 kg/m^2) and obese group(17 cases, BMI>27.5 kg/m^2). The changes of fasting blood glucose(FPG), glycosylated hemoglobin(HbA1 c), fasting C-peptide(FCp), fasting insulin(FIns) and complications were analyzed before and 3, 6, 9 and 12 months after operation. Results All 28 cases were successfully operated. There were no significant differences in operation time or bleeding volume between the two groups(t=0.642, 0.871, P=0.526, 0.392). No serious complications occurred after operation. BMI, FPG, HbA1 c, FCp and FIns in both groups showed a continuous downward trend with time, and the levels were significantly lower than those before operation(P<0.05). The level of FCp in non-obese group was significantly lower than that in obese group at 12 months after operation(t=0.711, P<0.05). The complete remission rates of T2DM in non-obese group and obese group were 72.7%(8/11) and 82.4%(14/17), respectively, with no significant difference(χ^2=0.368, P=0.544). Conclusion LRYGB can significantly reduce BMI and improve glucose metabolism for non-obese T2DM, and the short-term postoperative safety is reliable.