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目的探讨腹腔镜下胃旁路手术治疗重度肥胖(体重指数≥35)2型糖尿病的有效性。方法 2012年6月~2013年6月,参照《中国2型糖尿病防治指南(2010)》选择体重指数(BMI)≥35、病史<15年且药物治疗或使用胰岛素难以满意控制血糖及并发症的36例重度肥胖2型糖尿病患者实施腹腔镜胃旁路手术,并随访1年。结果术后1、3、6、12个月体重、BMI、腰围、臀围、腰臀比、空腹血糖、空腹胰岛素、空腹C肽、餐后2 h血糖、餐后2 h胰岛素、餐后2 h C肽、糖化血红蛋白、胰岛素抵抗指数(HOMA-IR)、多余体重减少百分比(%EWL)与术前比较均明显改善(P<0.01)。术后1年胃旁路手术治疗2型糖尿病完全缓解33例,明显改善2例,无效1例。有效率97.2%(35/36)。结论腹腔镜下胃旁路手术对国人重度肥胖伴2型糖尿病患者是一种有效的减重及降糖方法。餐后血糖下降在降低糖化血红蛋白中发挥更加重要的作用。
Objective To investigate the effectiveness of laparoscopic gastric bypass in the treatment of type 2 diabetes with severe obesity (body mass index ≥35). Methods From June 2012 to June 2013, according to Guide to Prevention and Treatment of Type 2 Diabetes in China (2010), patients with body mass index (BMI) ≥35, history of <15 years and difficult to control blood sugar and complications with medication or insulin Thirty-six patients with severe type 2 diabetes mellitus underwent laparoscopic gastric bypass surgery and were followed up for 1 year. Results Body weight, BMI, waist circumference, hip circumference, waist-hip ratio, fasting plasma glucose, fasting insulin, fasting C-peptide, postprandial 2h blood glucose, postprandial insulin 2h, postprandial 2 Hc peptide, HbA1c, HOMA-IR and% weight loss (% EWL) were significantly improved compared with those before operation (P <0.01). One year after operation of gastric bypass surgery in type 2 diabetes, complete remission in 33 cases, significantly improved in 2 cases, 1 case of ineffective. Efficiency 97.2% (35/36). Conclusions Laparoscopic gastric bypass surgery is an effective method for weight loss and glucose reduction in people with severe obesity and type 2 diabetes. Postprandial decline in blood glucose in reducing HbA1c play a more important role.