腹腔镜Roux-en-Y 胃旁路术在治疗2 型糖尿病及相关合并症中的应用价值

doi:10.3877/cma.j.issn.2095-9605.2015.01.008

中华肥胖与代谢病电子杂志 ›› 2015, Vol. 01 ›› Issue (01) : 30 -33. doi: 10.3877/cma.j.issn.2095-9605.2015.01.008

临床研究

腹腔镜Roux-en-Y 胃旁路术在治疗2 型糖尿病及相关合并症中的应用价值

高羽¹, 陈静², 童卫东¹^,^†(

), 李春穴¹, 李凡¹, 孙芳², 周训美², 阎振成², 祝之明²

1.400042 重庆，第三军医大学大坪医院野战外科研究所胃结直肠外科
2.400042 重庆，第三军医大学大坪医院高血压内分泌科

收稿日期:2015-02-28 出版日期:2015-05-30
通信作者: 童卫东

Application value of laparoscopic Roux-en-Y gastric bypass for type 2 diabetes mellitus and related diseases

Yu Gao¹, Jing Chen², Weidong Tong¹^,^†(), Chunxue Li¹, Fan Li¹, Fang Sun², Xunmei Zhou², Zhencheng Yan², Zhiming Zhu²

1.Department of Gastric ＆ Colorectal Surgery,Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042,China
2.Department of Hypertension ＆endocrine, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042,China

Received:2015-02-28 Published:2015-05-30
Corresponding author: Weidong Tong

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目的

分析腹腔镜胃旁路术（laparoscopic Roux-en-Y gastric bypass，LRYGB）治疗2型糖尿病（type 2 diabetes mellitus，T2DM）及相关合并症的疗效。

方法

回顾性分析2010年4月至2014年12月在第三军医大学大坪医院接受LRYGB治疗的70例T2DM患者的临床资料，术后1、3、6、12、24个月定期随访并检测人体质量指数（BMI）、腹围、空腹血糖、糖化血红蛋白（HbA1c）、血压及血脂等指标。术前和术后指标采用单因素方差分析进行比较。

结果

患者平均年龄46岁（25~69岁），平均BMI为29.3 kg/m²（22.2~44.6 kg/m²），T2DM病程为4.8年（1月～16年）。70例患者均顺利完成手术，无死亡病例，3例（4.3%）吻合口溃疡经保守治疗后治愈。随访1~24个月，术后BMI、腹围、空腹血糖及HbA1c等指标均显著降低（P＜0.05）。70例患者中，T2DM完全缓解45例（64.3%），血糖控制18例（25.7%），好转7例（10%），无效0例。34例合并高血压病和32例合并高脂血症的患者的血压及血脂指标均有明显改善（P＜0.05）。

结论

LRYGB对治疗T2DM及伴发的高血压病和高脂血症有良好的疗效，值得临床推广使用。

关键词: 腹腔镜Roux-en-Y胃旁路术, 糖尿病，2型, 高血压, 高脂血症

Objective

To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (RYGB)in treating type 2 diabetes mellitus (T2DM) and related complications.

Methods

The clinical data of 70 patients with T2DM who underwent laparoscopic Roux-en-Y gastric bypass from April 2010 to December 2014 was analysed. In the follow up, patients’body mass index (BMI), waist circumference, fasting plasma glucose, Hb1Ac, blood pressure and blood lipid in the postoperative time of 1, 3, 6, 12 and 24 months were checked in time. Preoperative and postoperative indexes were compared by one-factor ANOVA.

Results

The mean age of patients was 46 years (ranging from 25 to 69 years), the mean BMI was 29.3 kg/m² (ranging from 22.2 to 44.6 kg/m²) and the mean disease course of T2DM was 4.8 years (ranging from 1 month to 16 years). 70 cases were preformed smoothly without deaths. 3 (4.3%) marginal ulcers occurred and were cured with conservative treatment. The postoperative follow up time was from 1 to 24 months, the indexes of BMI, waist circumference, FPG, Hb1Ac were significantly decreased(P＜0.05). In the 70 cases,45 cases(64.3%) showed complete remission of T2DM, 18 cases （25.7%）showed glycemic control, 7 cases (10%)showed improvement, and 0 showed invalidity. The levels of blood pressure and blood lipid were improved significantly for 34 cases with hypertension and 32 cases with hyperlipidemia.

Conclusions

LRYGB has good effects for treating T2DM and relative complications such as hypertension and hyperlipidemia.

Key words: Laparoscopic Roux-en-Y gastric bypass, Diabetes mellitus, Type 2, Hypertension, Hyperlipidemias

表1 合并高脂血症的T2DM 患者行LRYGB 术前后血脂水平的比较（mmol/L，±s）

观察时间	例数	TC	TG	HDL	LDL
术前	32	5.4±1.4	3.5±2.5	1.4±1.1	2.6±0.6
术后1个月	32	4.4±0.9*	1.7±1.0*	1.3±0.3	2.8±0.8
术后3个月	32	4.0±1.2*	1.7±1.2*	1.4±0.3	2.7±0.8
术后6个月	32	4.1±0.9*	1.2±0.5*	1.3±0.2	2.6±0.8
术后12个月	32	4.2±1.2*	1.7±1.2*	1.4±0.3	2.5±0.9
术后24个月	32	4.2±1.0*	1.1±0.4*	1.3±0.3	2.7±0.9

表1 合并高脂血症的T2DM 患者行LRYGB 术前后血脂水平的比较（mmol/L，±s）

观察时间	例数	TC	TG	HDL	LDL
术前	32	5.4±1.4	3.5±2.5	1.4±1.1	2.6±0.6
术后1个月	32	4.4±0.9*	1.7±1.0*	1.3±0.3	2.8±0.8
术后3个月	32	4.0±1.2*	1.7±1.2*	1.4±0.3	2.7±0.8
术后6个月	32	4.1±0.9*	1.2±0.5*	1.3±0.2	2.6±0.8
术后12个月	32	4.2±1.2*	1.7±1.2*	1.4±0.3	2.5±0.9
术后24个月	32	4.2±1.0*	1.1±0.4*	1.3±0.3	2.7±0.9

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