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目的探讨腹腔镜Roux-en-Y胃旁路术(Laparoscopic Roux—en-Y gastric bypass,LRYGB)对2型糖尿病(type 2 diabetes mellitus,T2DM)及其并发症的长期临床疗效。方法回顾性分析我院收治的48例T2DM患者的临床资料。术后随访4年,分析术前及术后体重指数(BMI)、腰臀比(WHR)、糖脂代谢指标的变化。同时观察T2DM相关并发症的改善情况。结果48例手术均在腹腔镜下顺利完成,无一例中转开腹,随访期间,无死亡病例及严重手术并发症发生。48例T2DM患者的BMI及WHR在术后3个月、6个月、1年、2年、3年、4年均较术前显著下降,差异有统计学意义(P<0.05)。同时,糖代谢相关指标空腹血糖(FPG)、标准馒头餐后2h血糖(2h PG)、空腹C肽(FC-P)、糖化血红蛋白(HbA1c)于术后各时间点均较术前明显下降(P<0.05)。与术前比较,脂代谢相关指标TC、TG、HDL、LDL于术后各时间点均较术前明显改善(P<0.05)。48例接受LRYGB的T2DM患者有效率达100%。结论腹腔镜Roux-en-Y胃旁路术是治疗2型糖尿病的一种安全有效的手术方式,完善的术前评估、围手术期规范化的管理及长期随访是保证手术疗效的关键。
Objective To investigate the long-term clinical efficacy of Laparoscopic Roux-en-Y gastric bypass (LRYGB) on type 2 diabetes mellitus (T2DM) and its complications. Methods The clinical data of 48 patients with T2DM admitted to our hospital were retrospectively analyzed. The patients were followed up for 4 years. The changes of body mass index (BMI), WHR and glucose and lipid metabolism before and after operation were analyzed. At the same time to observe the improvement of T2DM-related complications. Results All the 48 cases were performed successfully under laparoscopy without any conversion to laparotomy. No deaths or serious complications occurred during follow - up. The BMI and WHR of 48 patients with T2DM were significantly lower than those before operation at 3 months, 6 months, 1 year, 2 years, 3 years and 4 years after operation. The difference was statistically significant (P <0.05). At the same time, fasting blood glucose (FPG), 2h PG, FC-P and HbA1c in the standard steamed bread were significantly lower than those before the operation P <0.05). Compared with preoperative, the indexes of lipid metabolism TC, TG, HDL and LDL were significantly improved at all time points after operation (P <0.05). 48 cases of T2DM patients receiving LRYGB effective rate of 100%. Conclusions Laparoscopic Roux-en-Y gastric bypass is a safe and effective surgical treatment for type 2 diabetes. Perfecting preoperative evaluation, perioperative standard management and long-term follow-up are the keys to ensure surgical efficacy.