腹腔镜袖状胃切除术治疗肥胖合并2型糖尿病患者的近期疗效

Short-term effects of laparoscopic sleeve gastrectomy in patients with Obesity and Type 2 diabetes mellitus

目的探讨腹腔镜袖状胃切除术(LSG)治疗肥胖合并2型糖尿病(T2DM)患者的近期疗效。方法回顾性分析2015年6月至2019年3月接受LSG的95例肥胖合并T2DM患者临床资料。患者术后随访至少24个月,观察手术疗效和术后并发症情况。数据处理采用SPSS 22.0统计软件,术后并发症发生率用[n(%)]表示;手术前后体重相关指标、血糖、血脂指标等计量资料用(x±s)表示,多组间比较采用单因素方差分析。P<0.05为差异有统计学意义。结果LSG后12个月,患者完全缓解率81.1%(77/95),总有效率93.7%(89/95)。术后患者出现胃切缘出血(3例)、胃漏(1例)、胃角狭窄(1例),术后并发症总发生率为5.3%(5/95)。与术前相比,术后3、6、12个月患者身体质量指数(BMI)、腰臀比(WHR)水平均明显下降,且随时间逐步降低,患者术后多余体质量减少率(EWL%)随时间逐步上升(P<0.05);血清糖化血红蛋白(HbA1c)、空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)水平均明显降低,且随时间逐步降低(P<0.05);血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平均明显降低,且随时间逐步降低,而高密度脂蛋白胆固醇(HDL-C)均明显升高,且随时间逐步升高(P<0.05)。结论LSG治疗肥胖合并T2DM近期疗效确切,能够有效缓解病情,患者术后并发症较少,减重效果好,且能够有效控制患者糖脂代谢水平。

Objective To investigate the short-term efficacy of laparoscopic sleeve gastrectomy(LSG)in the treatment of obese patients with type 2 diabetes mellitus(T2DM).Methods Clinical data of 95 obese patients with T2DM who underwent LSG from June 2015 to March 2019 were analyzed retrospectively.The patients were followed up for at least 24 months to observe the efficacy and postoperative complications.The data were processed by SPSS 22.0 statistical software,the incidence of postoperative complications was expressed by[n(%)];Before and after operation,weight related indexes,blood glucose index,blood lipid index and other measurement data were expressed by(^±5).One-way AJSOVA was performed for comparison between multiple groups.P<0.05 was statistically significant.Results At 12 months after LSG,the complete remission rate was 81.1%(77/95),and the total response rate was 93.7%(89/95).Postoperative patients had gastric margin bleeding(3 cases),gastric leakage(1 case),gastric Angle stenosis(1 case),and the overall incidence of postoperative complications was 5.3%(5/95).Compared with preoperative,body mass index(BMI)and waist-hip ratio(WHR)levels were significantly decreased at 3,6 and 12 months after surgery,and gradually decreased with time,while the rate of excess body mass loss(EWL%)was gradually increased with time(P<0.05).Serum HbAlc,fasting blood glucose(FPG)and insulin resistance index(HOMA-IR)levels were significantly decreased with time(P<0.05).Serum total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)levels were significantly decreased,and gradually decreased with time,while high density lipoprotein cholesterol(HDL-C)levels were significantly increased,and gradually increased with time(P<0.05).Conclusion LSG has a definite short-term effect in the treatment of obesity complicated with T2DM,which can effectively alleviate the disease,reduce complications,reduce weight,and effectively control the glucose and lipid metabolism level of patients.