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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
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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]. 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]. 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
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