腹腔镜不同术式治疗肥胖症合并2型糖尿病的近、远期疗效分析

Short-term and long-term efficacy analysis of different laparoscopic surgical methods in the treatment of obesity complicated with type 2 diabetes mellitus

目的:对比分析腹腔镜袖状胃切除术(LSG)与胃旁路术(LRYGB)治疗肥胖症合并2型糖尿病的近、远期疗效。方法:选取2015年1月至2017年12月收治的80例患者进行前瞻性研究,分别行LSG(LSG组)与LRYGB(LRYGB组),每组40例。对比分析两组患者恢复、减重、血糖下降情况及疗效。结果:LSG组手术时间、术中出血量、住院时间及术后首次进食时间优于LRYGB组(P<0.05);与术前相比,术后6、12、36个月两组患者空腹C肽、空腹血糖、胰岛素抵抗指数及糖化血红蛋白、甘油三酯、血清总蛋白、体重、BMI、腰围、臀围及腰臀比均下降(P<0.05),多余体重减少百分比、血清白蛋白、前白蛋白及谷丙转氨酶增加(P<0.05);两组间差异无统计学意义(P>0.05)。结论:LSG与LRYGB治疗2型糖尿病的近远期疗效相近,安全性均较高;但LSG相对简便且术后康复快,可优先考虑。

Objective:To compare and analyze the short-term and long-term efficacy of laparoscopic sleeve gastrectomy(LSG)and laparoscopic Roux-en-Y gastric bypass(LRYGB)in treatment of obesity complicated with type 2 diabetes mellitus.Methods:Eighty patients from Jan.2015 to Dec.2017 were enrolled in this prospective study.LSG and LRYGB was performed in LSG and LRYGB group respectively,with 40 patients in each group.The recovery,weight loss,glucose decrease and curative effect of the two groups were compared and analyzed.Results:The operation was successfully completed in all patients,and there were no serious complications such as bleeding and anastomotic leakage.The operation time,intraoperative blood loss,hospitalization time and postoperative first feeding time of LSG group were better than those of LRYGB group(P<0.05).Compared with data before operation,fasting C-peptide,fasting blood glucose,insulin resistance index,glycosylated hemoglobin A1c,triglyceride,total protein,body weight,BMI,waist circumference,hip circumference and waist-hip ratio were decreased in 2 groups at 6,12 and 36 months after operation(P<0.05),overweight body weight loss percentage,albumin,prealbumin and glutamic-pyruvic transaminase were increased(P<0.05);There was no significant difference between the two groups(P>0.05).Conclusions:The short-term and long-term efficacy of LSG and LRYGB in the treatment of T2DM is similar,and the safety is higher,but LSG is relatively simple and patients recover quickly after the operation,so it can be given priority.