切换至 "中华医学电子期刊资源库"
高级检索
中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2015, Vol. 01 ›› Issue (01) : 16 -20. doi: 10.3877/cma.j.issn.2095-9605.2015.01.005

临床研究

袖状胃切除联合十二指肠-空肠转流术在非肥胖型2 型糖尿病中的应用价值
殷骏1, 毛忠琦1,†(), 徐露1, 朱政1, 陈昕1, 周晓俊1, 钱海鑫1   
  1. 1.215006 苏州，苏州大学附属第一医院腹腔镜微创外科
  • 收稿日期:2015-01-30 出版日期:2015-05-30
  • 通信作者: 毛忠琦
  • 基金资助:
    2013 苏州市卫生局科教兴卫专项资金（LCZX201303）

Application value of the clinical curative effect for laparoscopic sleeve gastrectomy with duodeno-jejunal bypass to treat non-obese type 2 diabetes

Jun Yin1, Zhongqi Mao1,†(), Lu Xu1, Zheng Zhu1, Xin Chen1, Xiaojun Zhou1, Haixin Qian1   

  1. 1.Department of Laparoscopic Surgery, the First Affiliated Hospital of Suzhou University,Suzhou 215006, China
  • Received:2015-01-30 Published:2015-05-30
  • Corresponding author: Zhongqi Mao
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

殷骏, 毛忠琦, 徐露, 朱政, 陈昕, 周晓俊, 钱海鑫. 袖状胃切除联合十二指肠-空肠转流术在非肥胖型2 型糖尿病中的应用价值[J/OL]. 中华肥胖与代谢病电子杂志, 2015, 01(01): 16-20.

Jun Yin, Zhongqi Mao, Lu Xu, Zheng Zhu, Xin Chen, Xiaojun Zhou, Haixin Qian. Application value of the clinical curative effect for laparoscopic sleeve gastrectomy with duodeno-jejunal bypass to treat non-obese type 2 diabetes[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2015, 01(01): 16-20.

目的

探讨腹腔镜袖状胃切除联合十二指肠-空肠转流术（laparoscopic sleeve gastrectomyduodenojejunal bypass，LSG-DJB）治疗非肥胖型2型糖尿病的疗效。

方法

收集苏州大学附属第一医院2012年6月至2013年12月应用LSG-DJB治疗的12例非肥胖型（BMI＜30 kg/m2）2型糖尿病患者的临床资料，记录患者的住院时间，手术时间，手术失血量，手术相关并发症，患者术前和术后1、3、6、12个月的体重、BMI、腰围、空腹血糖（FPG）、口服葡萄糖耐量试验、糖化血红蛋白（HbA1c）、血脂及糖尿病等并发症变化的临床资料，以上临床数据的比较采用t检验。

结果

所有患者均顺利完成手术，无围手术期死亡患者；1例术后出现烧心感等食道返流症状，经保守治疗后好转；术后患者的FPG、HbA1c、胰岛素抵抗指数（HOMA-IR）、C肽、体重、BMI、腰围、血清甘油三酯（TG）、低密度脂蛋白（LDL-C）等均较术前显著下降（P＜0.05）；术后1年，9名患者因2型糖尿病缓解而停药，其中3例彻底治愈（HbA1c＜6.0%），6例得到控制（HbA1c＜7.0%），另外3例降糖药物减量。

结论

LSG-DJB可安全施行于非肥胖型2型糖尿病患者，能有效控制体重，改善血糖、血脂水平及相关合并症，近期疗效较好，远期疗效尚有待进一步观察。

关键词: 腹腔镜下袖状胃切除联合十二指肠-空肠转流术, 糖尿病，2型, 治疗结果

Objective

To explore the clinical effectiveness and safety of laparoscopic sleeve gastrectomy-duodenojejunal bypass (LSG+DJB) in the non-obese diabetes patients.

Methods

The data of 12 non-obese patients with type 2 diabetes mellitus who underwent LSG+DJB from June 2012 to December 2013 were analyzed, including the length of hospitalization, operative time, blood loss, operative related complications and weight, BMI, waist circumference, fasting plasma glucose (FPG), oral glucose tolerance test, HbA1c, blood lipids and the changing of diabetes complications at pre and postoperative time of 1,3,6 and 12 months.

Results

All the procedures were preformed smoothly without perioperative death. Esophageal reflux symptoms such as heartburn happened to one case after the procedure, and released after conservative treatment. The FPG, HbA1c, HOMA-IR, C-peptide, weight, BMI, waist circumference, serum triglyceride(TG), low density lipoprotein cholesterol (LDL-C) of the patients were declined significantly after the procedure (P＜0.05). One year after the procedures, 9 cases stopped taking medicine because of the remission of T2DM, including 3 cases completely cured (HbA1c＜6.0%) and 6 cases controlled (HbA1c＜7.0%), and the other 3 cases decreased hypoglycemic agent.

Conclusions

LSG+DJB performed safely in non-obese patients with type 2 diabetes with the good effectiveness of controlling weights, improving blood glucose,blood lipid and related complications. The short-term effectiveness is good, but the long-term effectiveness remains further observation.

Key words: Laparoscopic sleeve gastrectomy- duodenojejunal bypass, Diabetes mellitus, Type 2, Treatment outcome
表1 T2DM 患者行LSG+DJB 前后临床指标变化情况（±s，n=12）
观察时间 BMI（kg/m2） 体重（kg） 腰围（cm） FPG（mmol/L） HbA1c（%）
术前 25.0±2.7 68±13 88±6 8.5±2.7 9.0±1.9
术后1个月 23.3±3.7* 63±13* 82±9* 7.0±1.4 7.4±1.0*
术后3个月 22.1±3.2* 59±12* 79±8* 6.7±1.0 6.9±1.4*
术后6个月 21.5±2.5* 58±12* 78±8* 6.3±1.0* 6.6±0.8*
术后12个月 21.2±2.3* 57±10* 76±8* 6.2±0.9* 6.4±0.6*
t值 8.615 6.486 6.265 2.976 4.441
P值 ＜0.05 ＜0.05 ＜0.05 ＜0.05 ＜0.05
观察时间 C肽（μg/L） HOMA-IR Ipeak/I0 TG（mmol/L） HDL-C（mmol/L） LDL-C（mmol/L）
术前 2.4±0.9 4.7±4.7 2.7±1.7 3.1±2.8 1.1±0.3 2.3±0.6
术后1个月 2.3±0.9 3.3±2.1* - 1.7±0.8 1.2±0.4 2.6±0.6
术后3个月 2.1±0.9 2.2±1.3* - 1.5±1.1* 1.1±0.3 2.4±0.7
术后6个月 1.9±0.7* 2.2±1.5* 7.2±8.3* 1.2±1.1* 1.3±0.3* 2.3±0.7
术后12个月 1.7±0.6* 1.7±1.6* 10.0±8.4* 0.9±0.4* 1.4±0.2* 2.2±0.5
t值 3.881 3.166 4.346 3.122 3.791 1.733
P值 ＜0.05 ＜0.05 ＜0.05 ＜0.05 ＜0.05 ＞0.05
[1]
Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus[J]. Ann Surg, 1995, 222(3):339-350.
[2]
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011[J]. Obes Surg, 2013, 23(4):427-436.
[3]
Wild S, Roglic G, Green A, et al. Global prevalence of diabetes:estimate for the year 2000 and projections for 2030[J]. Diabetes Care,2004, 27(5):1047-1053.
[4]
Peterli R, Wölnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery:comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial[J]. Ann Surg, 2009, 250(2):234-241.
[5]
Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss,appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study[J]. Ann Surg, 2008,247(3):401-407.
[6]
Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus:a randomized controlled trial[J]. Arch Surg, 2011, 146(2):143-148.
[7]
Ramos AC, Galvão Neto MP, de Souza YM, et al. Laparoscopic duodenal-jejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI＜30 kg/m2 (LBMI)[J]. Obes Surg,2009,19(3):307-312.
[8]
Ferzli GS, Dominique E, Ciaglia M, et al. Clinical improvement after duodenojejunal bypass for nonobese type 2 diabetes despite minimal improvement in glycemic homeostasis[J]. World J Surg, 2009,33(5):972-979.
[9]
Søvik TT, Taha O, Aasheim ET, et al. Randomized clinical trial of Laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity[J]. Br J Surg, 2010, 97(2):160-166.
[10]
Aasheim ET, Björkman S, Søvik TT, et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch[J]. Am J Clin Nutr, 2009, 90(1):15-22.
[11]
Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes[J].N Engl J Med,2012, 366(17):1577-1585.
[12]
Kasama K, Tagaya N, Kanehira E, et al. Laparoscopic sleeve gastrectomy with duodenojejunal bypass:technique and preliminary results[J]. Obes Surg, 2009, 19(10):1341-1345.
[13]
Sánchez-Pernaute A, Rubio Herrera MA, Pérez-Aguirre E, et al.Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy:proposed technique[J]. Obes Surg, 2007, 17(12):1614-1618.
[14]
Corsini DA, Simoneti CA, Moreira G, et al. Cancer in the excluded stomach 4 years after gastric bypass[J]. Obes Surg, 2006, 16(7):932-934.
[15]
Harper J, Beech D, Tichansky DS, et al. Cancer in the bypassed stomach presenting early after gastric bypass[J]. Obes Surg, 2007,17(9):1268-1271.
[16]
Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes[J]. Ann Surg, 2006, 244(5):741-749.
[1] 王颉, 周游. 二甲双胍治疗骨关节炎的机制及其研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 372-378.
[2] 刘正宇, 刘春风, 王振. 改良后外侧入路半髋置换治疗股骨颈骨折的早期疗效[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 409-413.
[3] 刘昌盛, 江思, 童娟. 可视化超声引导下针刀治疗狭窄性腱鞘炎的疗效分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 160-166.
[4] 唐艳, 赵小虎, 栗玉姣, 顾向梅. 针刀治疗老年膝骨关节炎的肌骨超声特征与疗效相关性[J/OL]. 中华关节外科杂志(电子版), 2024, 18(01): 48-53.
[5] 许正文, 李振, 侯振扬, 苏长征, 朱彪. 富血小板血浆联合植骨治疗早期非创伤性股骨头坏死[J/OL]. 中华关节外科杂志(电子版), 2023, 17(06): 773-779.
[6] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J/OL]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[7] 高玲, 于哲, 范然, 臧银善. 外周血细胞计数比值评估类风湿关节炎疗效的价值[J/OL]. 中华关节外科杂志(电子版), 2023, 17(05): 642-647.
[8] 王卉, 薛宝睿, 李恭驰, 刘慧真, 雷霞, 李炳辉. 2型糖尿病患者下肢动脉硬化的影响因素分析[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(02): 147-152.
[9] 朴成林, 蓝炘, 司振铎, 李强, 冯健, 安峰铎, 冷建军. 胰十二指肠切除联合肝切除术疗效分析：附5例报告（附视频）[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 363-367.
[10] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[11] 许月芳, 刘旺, 曾妙甜, 郭宇姝. 多粘菌素B和多粘菌素E治疗外科多重耐药菌感染临床疗效及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 700-703.
[12] 张海涛, 康婵娟, 翟静洁. 胰管支架置入治疗急性胆源性胰腺炎效果观察[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(06): 654-657.
[13] 陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[14] 王峰杰, 王礼光, 廖珊, 刘颖, 符荣党, 陈焕伟. 腹腔镜右半肝切除术治疗肝癌的安全性与疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 517-522.
[15] 张政赢, 鞠阳, 刘晓宁. 二甲双胍对2型糖尿病患者大肠腺瘤术后复发的影响[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(06): 485-488.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号

AI
小
编
AI小编
你好！我是《中华医学电子期刊资源库》AI小编，有什么可以帮您的吗？