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 ›› 2022, Vol. 08 ›› Issue (02) : 87 -92. doi: 10.3877/cma.j.issn.2095-9605.2022.02.003

论著

腹腔镜袖状胃切除联合双通路手术的短期疗效研究
单晓东1, 严雨2, 陈有为3, 褚薛慧1, 孙喜太1,†()   
  1. 1. 210008　南京，南京大学医学院附属鼓楼医院普外科
    2. 东南大学医学院
    3. 南京大学医学院
  • 收稿日期:2022-03-02 出版日期:2022-05-30
  • 通信作者: 孙喜太
  • 基金资助:
    南京市卫生科技发展专项资金项目(YKK20078); 南京鼓楼医院新技术发展基金培育项目(XJSFZJJ202027)

Short-term clinical efficacy of laparoscopic sleeve gastrectomy with transit bipartition

Xiaodong Shan1, Yu Yan2, Youwei Chen3, Xuehui Chu1, Xitai Sun1,†()   

  1. 1. Department of General Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School
    2. Southeast University Medical School
    3. Nanjing University Medical School, Nanjing 210008, China
  • Received:2022-03-02 Published:2022-05-30
  • Corresponding author: Xitai Sun
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

单晓东, 严雨, 陈有为, 褚薛慧, 孙喜太. 腹腔镜袖状胃切除联合双通路手术的短期疗效研究[J/OL]. 中华肥胖与代谢病电子杂志, 2022, 08(02): 87-92.

Xiaodong Shan, Yu Yan, Youwei Chen, Xuehui Chu, Xitai Sun. Short-term clinical efficacy of laparoscopic sleeve gastrectomy with transit bipartition[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(02): 87-92.

目的

探讨腹腔镜袖状胃切除联合双通路手术（LSG+TB）治疗肥胖合并2型糖尿病的短期临床疗效。

方法

采用回顾性队列研究，收集从2020年7月至2021年6月在南京大学医学院附属鼓楼医院实施LSG+TB的13例合并2型糖尿病的肥胖症患者的临床资料。观察分析患者术后3月、6月的体重、血糖、营养指标的变化以及并发症的发生情况。

结果

13例患者均完成了术后3月、6月随访。患者BMI术前为（35.67±3.11）kg/m2，术后3月、6月分别降至（28.63±3.12）kg/m2、（25.58±1.92）kg/m2，下降趋势显著（F=231.09，P<0.001）；患者术后3月、6月的多余BMI减少百分比（%EBMIL）分别为（69.93±19.97）%、（97.51±16.18）%。患者空腹血糖（FPG）由术前的（8.47±3.21）mmol/L，分别降至术后3月、6月的（5.14±0.69）mmol/L、（4.93±0.55）mmol/L（F=16.08，P<0.05）；患者糖化血红蛋白（HbA1c）由术前的（7.90±1.88）%，分别降至术后3月、6月的（5.17±0.66）%、（5.14±0.37）% （F=31.10，P<0.001）。术后3例（23%）患者出现轻度缺铁性贫血；2例（15%）患者诉腹泻（大便次数>3次/日）；另有1例（8%）患者诉排气较臭。术后未出现营养不良以及维生素缺乏等并发症。

结论

LSG+TB减重降糖效果显著，短期营养相关并发症发生率相对较低，且安全可靠，可以作为治疗肥胖合并2型糖尿病术式选择之一。

关键词: 2型糖尿病, 肥胖, 腹腔镜, 袖状胃切除术, 双通路手术
Objective

To explore the short-term efficacy of laparoscopic sleeve gastrectomy with transit bipartition (LSG+TB) in the treatment of obesity with T2DM.

Methods

A retrospective cohort study was conducted to investigate the clinical data of 13 obese patients with T2DM who underwent LSG+TB in Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital from July 2020 to June 2021. The changes of body weight, blood glucose and nutritional indexes and the occurrence of complications were observed and analyzed during 6 months post operation.

Results

All 13 patients were followed up 3 and 6 months after operation. Preoperative BMI of the patients decreased from (35.67±3.11) kg/m2 to (28.63±3.12) kg/m2 and (25.58±1.92) kg/m2 at 3 and 6 months post operation, respectively, with a significant downward trend, and there was statistically significant differences among groups (F=231.09, P<0.001). The %EBMIL at 3 and 6 months post operation was (69.93±19.97)% and (97.51±16.18)%, respectively. Fasting blood glucose decreased from (8.47±3.21) mmol/L before operation to (5.14±0.69) mmol/L and (4.93±0.55) mmol/L 3 and 6 months post operation, respectively, with a statistically significant downward trend (F=16.08, P<0.05). HbA1c decreased from (7.90±1.88)% before operation to (5.17±0.66)% and (5.14±0.37)% 3 and 6 months post operation, respectively, with a statistically significant downward trend (F=31.10, P<0.001). There were 3 cases (23%) mild iron deficiency anemia, 2 cases (15%) diarrhea (stool frequency >3 times/day), 1 case (8%) smelly exhaust. There were no complications such as malnutrition and vitamin deficiency.

Conclusions

LSG+TB might safely and effectively reduce excess weight and alleviate hyperglycemia, with the relatively low incidence of short-term nutrition-related complications, and might be used as one of the surgical options for the treatment of obesity with T2DM.

Key words: T2DM, Obesity, Laparoscope, Sleeve gastrectomy, Transit bipartition
图1 SG+TB手术步骤示意图。A：袖状胃切除；B：胃肠侧侧吻合；C：胃肠吻合口；D：关闭共同开口；E：切除近端小肠上的共同开口；F：肠肠吻合G：关闭小肠系膜裂孔；H：关闭Peterson系膜裂孔
表1 患者术前一般资料
指标 术前（±s）
年龄（岁） 29.0±11.4
性别（男/女） 1/12
体重（kg） 93.98±9.94
BMI（kg/m2） 35.67±3.11
FPG（mmol/L） 8.47±3.21
HbA1c（%） 7.90±1.88
HOMA-IR 6.60±4.78
合并症（n）  
  2型糖尿病 13
  非酒精性脂肪肝 13
  高血压 13
  高脂血症 4
  睡眠呼吸暂停综合征 10
表2 患者随访指标比较
指标 随访
A（n=13） B（n=13） C（n=13） F值 P值 A vs. B B vs. C A vs. C
体重（kg） 93.98±9.94 75.59±10.13 67.52±7.00 236.11 <0.001 t=16.81, *P<0.001 t=7.30, *P<0.001 t=17.61, *P<0.001
BMI（kg/m2） 35.67±3.11 28.63±3.12 25.58±1.92 231.09 <0.001 t=15.76, *P<0.001 t=7.48, *P<0.001 t=17.57, *P<0.001
HbA1c（%） 7.90±1.88 5.17±0.66 5.14±0.37 31.10 <0.001 t=5.79, *P<0.001 t=0.20, *P=0.85 t=5.66, *P<0.001
FPG（mmol/L） 8.47±3.21 5.14±0.69 4.93±0.55 16.08 <0.05 t=3.93, *P<0.05 t=3.02, *P<0.05 t=4.09, *P<0.05
HOMA-IR 6.60±4.78 2.12±1.48 1.44±0.53 15.66 <0.05 t=4.01, *P<0.05 t=1.95, *P=0.08 t=4.03, *P<0.05
白蛋白（g/L） 41.87±2.97 43.67±2.02 43.60±1.72 3.34 0.07 t=-2.01, *P=0.07 t=0.17, *P=0.87 t=-1.88, *P=0.09
叶酸（ng/mL） 13.31±4.82 16.84±4.12 17.68±3.79 5.22 <0.05 t=-2.04, *P=0.06 t=-1.14, *P=0.28 t=-2.69, *P<0.05
维生素B12（pg/mL） 581.15±236.89 787.08±288.98 759.85±278.78 4.42 <0.05 t=-2.49, *P<0.05 t=0.38, *P=0.71 t=-2.53, *P<0.05
维生素D（ng/mL） 15.35±4.30 23.05±9.56 23.44±8.71 10.36 <0.05 t=-3.44, *P<0.05 t=-0.26, *P=0.80 t=-3.68, *P<0.05
[1]
Borgeraas H, Hofsø D, Hertel JK, et al.Comparison of the effect of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials [J]. Obes Rev, 2020, 21(6):e13011.
[2]
Madadi F, Jawad R, Mousati I, et al. Remission of type 2 diabetes and sleeve gastrectomy in morbid obesity: a comparative systematic review and meta-analysis [J]. Obes Surg, 2019, 29(12):4066-4076.
[3]
Feng W, Yin T, Chu X, et al.Metabolic effects and safety of Roux-en-Y gastric bypass surgery vs. conventional medication in obese Chinese patients with type 2 diabetes [J]. Diabetes Metab Res Rev, 2019, 35(5):e3138.
[4]
Santoro S, Malzoni CE, Velhote MC, et al. Digestive adaptation with intestinal reserve: a neuroendocrine-based operation for morbid obesity [J]. Obes Surg, 2006, 16(10):1371-1379.
[5]
Cohen RV, Shikora S, Petry T, et al. The diabetes surgery summit II guidelines: a disease-based clinical recommendation [J]. Obes Surg, 2016, 26(8):1989-1991.
[6]
Bhandari M, Fobi MAL, Buchwald JN, et al.Standardization of bariatric metabolic procedures: world consensus meeting statement [J]. Obes Surg, 2019, 29(Suppl 4): 309-345.
[7]
Huang CK, Katakwar A. Sleeve plus procedures: need of time [J]. Surg Today, 2020 ,50(4):419-422.
[8]
Santoro S, Castro LC, Velhote MC, et al. Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity [J]. Ann Surg, 2012, 256(1): 104-110.
[9]
Al M, Taskin HE. Sleeve gastrectomy with transit bipartition in a series of 883 patients with mild obesity: early effectiveness and safety outcomes [J]. Surg Endosc, 2022, 36(4): 2631-2642.
[10]
Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? [J]. Diabetes Care, 2009, 32(11): 2133-2135..
[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]
Misra S, Nandhini BD, Christinajoice S, et al. Is laparoscopic Roux-en-Y gastric bypass still the gold standard procedure for indians? mid- to long-term Outcomes from a tertiary care center [J]. Obes Surg, 2020, 30(11):4482-4493.
[13]
Lebel S, Dion G, Marceau S, et al. Clinical outcomes of duodenal switch with a 200-cm common channel: a matched, controlled trial [J]. Surg Obes Relat Dis, 2016, 12(5): 1014-1020.
[14]
Topart P, Becouarn G, Ritz P. Weight loss is more sustained after biliopancreatic diversion with duodenal switch than Roux-en-Y gastric bypass in superobese patients [J]. Surg Obes Relat Dis, 2013, 9(4):526-530.
[15]
Kapeluto JE, Tchernof A, Masckauchan D, et al. Ten-year remission rates in insulin-treated type 2 diabetes after biliopancreatic diversion with duodenal switch [J]. Surg Obes Relat Dis, 2020, 16(11): 1701-1712.
[16]
Bianchi A, Pagan-Pomar A, Jimenez-Segovia M, et al. Biliopancreatic diversion in the surgical treatment of morbid obesity: long-term results and metabolic consequences [J]. Obes Surg, 2020, 30(11):4234-4242.
[17]
Karaca FC. Effects of sleeve gastrectomy with transit bipartition on glycemic variables, lipid profile, liver enzymes, and nutritional status in type 2 diabetes mellitus patients [J]. Obes Surg, 2020, 30(4):1437-1445.
[18]
Calisir A, Ece I, Yilmaz H, et al. The mid-term effects of transit bipartition with sleeve gastrectomy on glycemic control, weight loss, and nutritional status in patients with type 2 diabetes mellitus: a retrospective analysis of a 3-year follow-up [J]. Obes Surg, 2021, 31(11):4724-4733.
[19]
Bilecik T. Metabolic effects of sleeve gastrectomy with transit bipartition in obese females with type 2 diabetes mellitus: results after 1-year follow-up [J]. Obes Surg, 2019, 29(3):805-810.
[20]
Topart P, Becouarn G, Finel JB. Comparison of 2-year results of Roux-en-Y gastric bypass and transit bipartition with sleeve gastrectomy for superobesity [J]. Obes Surg, 2020, 30(9):3402-3407.
[21]
Rodrigues MR, Santo MA, Favero GM, et al. Metabolic surgery and intestinal gene expression: digestive tract and diabetes evolution considerations [J]. World J Gastroenterol, 2015, 21(22):6990-6998.
[22]
Lund A, Vilsbøll T, Bagger JI, et al. The separate and combined impact of the intestinal hormones, GIP, GLP-1, and GLP-2, on glucagon secretion in type 2 diabetes [J]. Am J Physiol Endocrinol Metab, 2011, 300(6):E1038-1046.
[23]
Al-Jafar H, Al-Zamil K, Al A M, et al. Potential hematology and nutritional complications of bariatric surgery [J]. Ann Hematol Oncol, 2018, 5(5): 1209.
[24]
Lupoli R, Lembo E, Saldalamacchia G, et al. Bariatric surgery and long-term nutritional issues [J]. World J Diabetes, 2017, 8(11):464-474.
[25]
姚立彬，邵永，洪健, 等. 腹腔镜胃袖状切除联合双通路手术41例短期疗效分析 [J]. 中国实用外科杂志, 2021, 41(09): 1024-1028..
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[10] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[11] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[12] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
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