腹腔镜袖状胃切除联合双通路手术的短期疗效研究

Short-term clinical efficacy of laparoscopic sleeve gastrectomy with transit bipartition

目的探讨腹腔镜袖状胃切除联合双通路手术(LSG+TB)治疗肥胖合并2型糖尿病的短期临床疗效。方法采用回顾性队列研究,收集从2020年7月至2021年6月在南京大学医学院附属鼓楼医院实施LSG+TB的13例合并2型糖尿病的肥胖症患者的临床资料。观察分析患者术后3月、6月的体重、血糖、营养指标的变化以及并发症的发生情况。结果13例患者均完成了术后3月、6月随访。患者BMI术前为(35.67±3.11)kg/m^(2),术后3月、6月分别降至(28.63±3.12)kg/m^(2)、(25.58±1.92)kg/m^(2),下降趋势显著(F=231.09,P<0.001);患者术后3月、6月的多余BMI减少百分比(%EBMIL)分别为(69.93±19.97)%、(97.51±16.18)%。患者空腹血糖(FPG)由术前的(8.47±3.21)mmol/L,分别降至术后3月、6月的(5.14±0.69)mmol/L、(4.93±0.55)mmol/L(F=16.08,P<0.05);患者糖化血红蛋白(HbA1c)由术前的(7.90±1.88)%,分别降至术后3月、6月的(5.17±0.66)%、(5.14±0.37)%(F=31.10,P<0.001)。术后3例(23%)患者出现轻度缺铁性贫血;2例(15%)患者诉腹泻(大便次数>3次/日);另有1例(8%)患者诉排气较臭。术后未出现营养不良以及维生素缺乏等并发症。结论LSG+TB减重降糖效果显著,短期营养相关并发症发生率相对较低,且安全可靠,可以作为治疗肥胖合并2型糖尿病术式选择之一。

Objective To explore the short-term efficacy of laparoscopic sleeve gastrectomy with transit bipartition(LSG+TB)in the treatment of obesity with T2DM.Methods A retrospective cohort study was conducted to investigate the clinical data of 13 obese patients with T2DM who underwent LSG+TB in Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital from July 2020 to June 2021.The changes of body weight,blood glucose and nutritional indexes and the occurrence of complications were observed and analyzed during 6 months post operation.Results All 13 patients were followed up 3 and 6 months after operation.Preoperative BMI of the patients decreased from(35.67±3.11)kg/m^(2)to(28.63±3.12)kg/m^(2)and(25.58±1.92)kg/m^(2)at 3 and 6 months post operation,respectively,with a significant downward trend,and there was statistically significant differences among groups(F=231.09,P<0.001).The%EBMIL at 3 and 6 months post operation was(69.93±19.97)%and(97.51±16.18)%,respectively.Fasting blood glucose decreased from(8.47±3.21)mmol/L before operation to(5.14±0.69)mmol/L and(4.93±0.55)mmol/L 3 and 6 months post operation,respectively,with a statistically significant downward trend(F=16.08,P<0.05).HbA1c decreased from(7.90±1.88)%before operation to(5.17±0.66)%and(5.14±0.37)%3 and 6 months post operation,respectively,with a statistically significant downward trend(F=31.10,P<0.001).There were 3 cases(23%)mild iron deficiency anemia,2 cases(15%)diarrhea(stool frequency>3 times/day),1 case(8%)smelly exhaust.There were no complications such as malnutrition and vitamin deficiency.Conclusions LSG+TB might safely and effectively reduce excess weight and alleviate hyperglycemia,with the relatively low incidence of short-term nutrition-related complications,and might be used as one of the surgical options for the treatment of obesity with T2DM.