机器人胃旁路术治疗低BMI 2型糖尿病患者的临床疗效观察

Clinical effect observation of robotic gastric bypass surgery in the treatment of type 2 diabetes patients with low BMI

目的 探讨机器人胃旁路术治疗低BMI 2型糖尿病(type 2 diabetes mellitus,T2DM)患者的临床疗效。方法选取2021年3月至2022年7月中南大学湘雅三医院行胃旁路手术治疗BMI <32.5 kg/m^(2)的T2DM患者71例。根据手术方式分为腹腔镜组(61例)和机器人组(10例),其中腹腔镜组采用腹腔镜下胃旁路手术,机器人组采用达芬奇机器人辅助胃旁路手术。按照1∶2倾向性得分进行匹配,术后随访3个月,比较两组患者手术、住院和随访情况。结果 71例患者中,男51例,女20例,年龄28~65岁,平均(47.7±8.6)岁。共有30例(腹腔镜组20例、机器人组10例)患者匹配成功,匹配后两组基线资料的比较,差异无统计学意义(P>0.05)。机器人组手术时间、住院费用高于腹腔镜组[(213.0±12.4)min比(161.9±4.8)min,(10.5±2.2)万元比(8.3±1.2)万元],术中出血量、术后首次肛门排气时间、住院时间低于腹腔镜组[(51.0±12.9)ml比(64.3±17.9)ml,2.5(2.0,3.0)d比3.0(3.0,4.8)d,(6.2±0.1)d比(8.1±0.3)d],差异均有统计学意义(P<0.05)。3个月后随访,两组并发症发生率、减重效果、糖代谢及肝肾功能指标的比较,差异均无统计学意义(P>0.05)。结论 与腹腔镜下胃旁路术相比,机器人辅助下胃旁路手术具有相似的疗效,且术中出血量、术后胃肠道功能恢复和住院时间更具有优势。

Objective To explore the clinical efficacy of robotic gastric bypass in the treatment of type 2 diabetes mellitus(T2DM) patients with low BMI.Methods A total of 71 T2DM patients with BMI 32.5 kg/m^(2) in the Third Xiangya Hospital of Central South University from March 2021 to July 2022 were selected,and were divided into laparoscopic group(61 cases) and robotic group(10 cases) according to the surgical methods.The laparoscopic group used laparoscopic gastric bypass surgery,and the robot group used Da Vinci robot-assisted gastric bypass surgery.Matching was performed by using a 1:2 propensity score to compare the operation,hospitalization and follow-up data between the two groups.Results Among the 71 patients,there were 51 males and 20 females,aged from 28 to 65 years,with an average age of(47.7 ± 8.6) year.A total of 30 cases(20 cases in the laparoscopic group and 10 cases in the robotic group) were successfully matched,and there were no statistical differences baseline data between the two groups after matching(all P>0.05).The operative time and hospitalization cost of the robot group were higher than those of the laparoscopic group [(213.0 ± 12.4) min vs.(161.9 ± 4.8)min,(10.5 ± 2.2) ten thousand RMB vs.(8.3 ± 1.2) ten thousand RMB],the intraoperative blood loss,the time of first anal exhaust after surgery and the length of hospitalization were lower than those of the laparoscopic group [(51.0 ± 12.9) ml vs.(64.3 ± 17.9) ml,2.5(2.0,3.0) d vs.3.0(3.0,4.8) d,(6.2 ± 0.1) d vs.(8.1 ± 0.3) d],the differences were statistically significant(all P<0.05).After three month of follow-up,there were no significant differences in the incidence of complications,weight loss,glucose metabolism,liver and kidney function between the two groups(all P>0.05).Conclusions Robotic-assisted gastric bypass surgery has the same efficacy as laparoscopic gastric bypass surgery,and has more advantages in intraoperative blood loss,postoperative gastrointestinal function recovery and hospitalization time.