目的

探讨腹腔镜胃旁路术（laparoscopic Roux-en-Y gastric bypass，LRYGB）与腹腔镜袖状胃切除术（laparoscopic sleeve gastrectomy，LSG）治疗肥胖症合并2 型糖尿病（type 2 diabetes mellitus，T2DM）的临床疗效及对血GLP-1 和Ghrelin 水平的影响。

方法

收集2012 年9 月至2014 年7 月在暨南大学附属第一医院普外科接受LRYGB、LSG 和单纯腹腔镜胃穿孔修补术患者的临床资料，每组各10 例。其中，接受LRYGB 和LSG 的患者均患有肥胖症合并T2DM。术后随访6 个月，采集相关指标进行对比分析。

结果

术后1～6 个月LRYGB 组和LSG 组患者的BMI、空腹血糖（FPG）及糖化血红蛋白（HbA1c）随时间推移呈下降趋势，与术前比较差异有统计学意义（P ＜0.05）。3 组术后血GLP-1 及血Ghrelin 检测结果显示，“手术方式”与“时间”之间存在交互作用，即不同手术方式对GLP-1 和Ghrelin 水平的影响不同（P ＜0.05）。

结论

LRYGB 与LSG 治疗肥胖症和2 型糖尿病均有显著的临床疗效，但机制上存在差异，仍需进一步研究以明确。

Objective

To explore the curative effects of laparoscopic Roux-en-Y gastric bypass(LRYGB) and laparoscopic sleeve gastrectomy (LSG) on obesity combined with type 2 diabetes mellitus(T2DM) as well as their influences on blood GLP-1 and Ghrelin levels.

Methods

Clinical data of those patients who underwent LRYGB, LSG or laparoscopic gastric perforation repair in the First Affiliated Hospital of Jinan University from September 2012 to June 2014 were retrospectively collected. 10 cases were recruited for each group, of which the patients in the LRYGB and LSG groups had suffered from obesity combined with T2DM. All patients were followed up 6 months after operations for collecting some correlative indexes for comparative analysis.

Results

In LRYGB and LSG groups, BMI, FPG and HbA1c levels decreased over time in 6 months after operations, significantly lower than those before operations(P ＜0.05). GLP-1 and Ghrelin levels were measured postoperatively in the three groups and an interaction was found between surgical method and time; it meaned that different surgical methods had different influences on GLP-1 and Ghrelin levels (P ＜0.05).

Conclusions

Both LRYGB and LSG have significant curative effects on obesity combined with T2DM, but they have different mechanisms. Further studies should be carried out to verify the specific mechanisms.