目的

探讨代谢手术治疗肥胖伴或不伴2 型糖尿病的疗效。

方法

回顾性分析2013 年1 月至2014 年12 月在复旦大学附属中山医院接受代谢手术治疗的26 例患者的临床资料。其中男11 例，女15 例；年龄19～64 岁。16 例被诊断为肥胖合并2 型糖尿病；5 例被诊断为糖尿病前期（空腹血糖受损及糖耐量减低）；5 例被诊断为单纯性肥胖症。收集并对比26 例患者手术前后的代谢参数指标。

结果

分别有16 例、13 例和10 例患者完成术后3 个月、6 个月和1 年随访。术后患者体重与BMI 呈下降趋势（P ＜0.05）。术后3 个月空腹血糖（5.5±1.3）mmol/L，餐后2 小时血糖（8.6±3.8）mmol/L，糖化血红蛋白（6.46±0.76）%；术后6 个月空腹血糖（4.8±0.7）mmol/L，餐后2 小时血糖（7.2±3.4）mmol/L，糖化血红蛋白（5.56±0.49）%；术后1 年血糖水平高于术后6 个月。术后3 个月、6 个月和1 年，肝脏脂肪含量平均下降分别为21.6%、25.1%和25.1%。

结论

代谢手术能明显降低患者体重、改善糖代谢情况。对于重度单纯性肥胖伴或不伴2 型糖尿病患者，手术治疗是减轻体重及肝脏脂肪含量、治疗糖尿病行之有效的手段。

Objective

To explore the curative effect of metabolic surgery for obesity with or without type 2 diabetes mellitus.

Methods

Clinical data of 26 patients undergoing metabolic surgery in Zhongshan Hospital of Fudan University from January 2013 to December 2014 was retrospectively analyzed. Among them, 11 were males and 15 were females, with the age ranging from 19 to 64 years old.16 cases were diagnosed as obesity combined with type 2 diabetes; 5 cases were diagnosed as prediabetes(impaired fasting glucose and glucose tolerance); 5 cases were diagnosed as simple obesity. Metabolic parameters of these 26 patients before and after surgery were collected and compared.

Results

Sixteen patients were followed up postoperatively for 3 months, 13 patients for 6 months and 10 patients for 1 year.Weight and BMI decreased over time after surgery (P＜0.05). At the 3 months postoperatively, average fasting blood glucose level was (5.5±1.3) mmol/L, 2-hour postprandial blood glucose was (8.6±3.8)mmol/L and HbA1c was (6.46±0.76)%. At the 6 months postoperatively, average fasting blood glucose level was (4.8±0.7) mmol/L, 2-hour postprandial blood glucose was (7.2±3.4) mmol/L and HbA1c was(5.56±0.49)%. Blood glucose level at 1 year after surgery was higher than that at 6 months. Average decline of liver lipid content were 21.6%, 25.1% and 25.1% respectively at 3 months, 6 months and 1 year after surgery.

Conclusions

Metabolic surgery can significantly reduce weight and improve blood glucose metabolism. For severe simple obesity with or without type 2 diabetes mellitus, surgical treatment is an effective method to reduce weight, liver lipid content and treat diabetes.