论文部分内容阅读
目的 探讨腹腔镜下Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)治疗2型糖尿病病人的临床有效性及安全性.方法 收集2010年5月—2012年2月临床病例共73例,均采用腹腔镜下胃旁路手术进行糖尿病治疗,其中有36例2型糖尿病患者已经完成了5年的随访调查.将患者分为高BMI组(BMI>27.5 kg/m2)和低BMI组(BMI≤27.5 kg/m2).详细记录内容包括患者的手术时间、住院时间、失血量、术后并发症等,还包括患者手术前后1、2、3、5年的各项指标,包括患者的体重、腰围、BMI、FPG、2hPG、HbA1c、C肽(CP)及血清胰岛素等.结果 所有73例进行腹腔镜下胃旁路手术治疗的患者均顺利出院,围手术期内无死亡病例,术后30 d内,手术相关并发症的比例为11.0%(8/73).手术后患者的FPG、HbA1c、BMI、血清甘油三酯、胆固醇等较术前均有显著下降(P<0.05).腹腔镜下胃旁路手术治疗2型糖尿病术后5年,低BMI组与高BMI组2型糖尿病的控制率分别为40.0%(6/15),76.2%(16/21),其差异有统计学意义(P<0.05).将2型糖尿病得到控制与得到改善病人的术前指标相比较,其中BMI、腰围、糖尿病病程、2hPG和2hCp差异有统计学意义(P27.5 kg/m2) and the low-BMI group (BMI≤27.5 kg/m2). Clinical data of patients, such as the length of hospital stay, operative time, blood loss, surgical operation related complications were recorded. All patients were subjected to follow-up controls with anthropometric and metabolic indices, such as weight, BMI, waist circumference, fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT), HbA1c, C peptide, serum insulin, blood lipids and the change of diabetes complications, etc, at 0.5, 1, 2, 3 and 5 years after surgery. Results All patients were discharged smoothly after surgery without perioperative death and surgery related complications were 11.0% (8/73). The FPG, HbA1c,weight, BMI, waist circumference, serum triglyceride and cholesterol of the patients were declined significantly (P<0.05) and rapidly after the operation. 76.2% (16/21) of the high-BMI group patients and 40.0% (6/15) of the low-BMI group patients with T2DM got remission after the surgery 5 years later. The difference between the remission rate of the two groups was statistically significant (P<0.05). Pre- operatively, the differences of BMI, waist circumference, course of T2DM, 2 hours postprandial plasma glucose (2hPG) and 2 hours postprandial blood C peptide (2hCp) between the remission group and the improvement group were statistically significant (P<0.05). Conclusion LRYGB can be performed safely on obese or non-obese patients with T2DM without severe complications. The effect is better in obese patients than in non-obese patients. LRYGB can effectively reduce the weight, control blood glucose and lipid levels in the patients with T2DM. The long-term effect is stabilization during 5 years. Pre-operative BMI, waist circumference, course of T2DM, 2hPG and 2hCp may be used as predictive indicators of the effectiveness of LRYGB.