非肥胖性2型糖尿病患者腹腔镜下空回肠侧侧吻合术的疗效分析

Laparoscopic side-to-side jejunoileal anastomosis for the treatment of non-obese type 2 diabetes mellitus

目的对2型糖尿病患者行腹腔镜下空回肠侧侧吻合术的可行性、安全性及疗效进行分析.方法回顾性分析2018年1-10月吉林省一汽总医院行腹腔镜下空回肠侧侧吻合术135例2型糖尿病患者的临床资料,比较患者术前、术后12个月的空腹血糖、糖化血红蛋白、C-肽、胰岛素、体重、BMI的变化以及影响预后的因素.结果135例患者均顺利完成腹腔镜下空回肠侧侧吻合术,平均手术时间为(87±17)min.术后12个月患者平均空腹血糖为(5.80±0.18)mmol/L,糖化血红蛋白为5.9%±0.4%,空腹C-肽为(1.32±0.21)nmol/L,空腹胰岛素为(42±54)mU/L,与术前比较差异均有统计学意义(t=10.654,12.657,11.214,10.698,均P<0.05).术后12个月平均体重为(72.4±9.9)kg,BMI为(25.6±2.8)kg/m2,与术前比较差异无统计学意义(t=7.658,6.958,P>0.05).术前糖化血红蛋白控制在8%以下、病史≤10年的患者术后治愈率分别为64.3%、68.2%,优于术前糖化血红蛋白控制在8%以上、病史>10年的患者(分别为40.4%、42%).结论腹腔镜下空回肠侧侧吻合术治疗非肥胖性2型糖尿病近期效果好,安全可行.

Objective To analyze the feasibility,safety and clinical efficacy of laparoscopic side-to-side jejunoileal anastomosis in the treatment of non-obese type 2 diabetes patients(BMI^32.5 kg/m2).Methods The clinical data of 135 patients who underwent laparoscopic side-to-side jejunoileal anastomosis at our hospital from Jan 2018 to Oct 2018 were retrospectively analyzed.They were followed up for 12 months until the end of Oct 2019.SPSS software was used to compare patients,fasting blood glucose,glycosylated hemoglobin,c-peptide,insulin,body weight,BMI with the values after 12 months of the surgery,and then evaluate factors affecting the prognosis.Results 135 patients successfully completed laparoscopic side-to-side jejunoileal anastomosis without conversion to open surgery.After 12 months of the operation,the patients’fasting blood glucose was(5.80±0.18)mmol/L,glycosylated hemoglobin was 5.9%±0.4%,fasting c-peptide was(1.32±0.21)nmol/L,and fasting insulin was(42±54)mU/L(t=10.654,12.657,11.214,10.698,all P<0.05).The body weight was(72.4±9.9)kg,BMI was(25.6±2.8)kg/m2,and the difference was not statistically significant(t=1.658,6.958,P>0.05).In patients with preoperative glycosylated hemoglobin controlled below 8% and the duration of T2DM less than 10 years,the chances being cured was better than that of those with glycosylated hemoglobin>8%and the medical history>10 years.Conclusion Laparoscopic side-to-side jejunoileal anastomosis in the treatment of nonobese type 2 diabetes is effective,safe and reliable.