胃旁路术对2型糖尿病患者的三年疗效分析

doi:10.3877/cma.j.issn.1674-6899.2018.05.003

目的

探讨腹腔镜胃旁路术(laparoscopic gastric bypass, LGBP)对中国2型糖尿病(type 2 diabetes mellitus, T2DM)患者术后3年的疗效及安全性。

方法

回顾性分析2012年4月至2014年3月在首都医科大学附属北京天坛医院接受LGBP治疗的58例T2DM患者的临床资料，观察术后3、6、9、12、24、36个月患者的体质量、血糖、血脂等指标，以及手术相关并发症，并用t检验或秩和检验比较手术前后相关指标的变化。

结果

58例T2DM患者全部完成LGBP，无中转开腹患者。患者的术后9个月体质量达到最低，术后12、24、36个月平均体质量均较术前明显减低，差异有统计学意义(P<0.05)。术后12、24、36个月T2DM完全缓解率分别为72.5%、71.4%、52.9%。空腹血糖(fasting plasmaglucose，FPG)在术后6个月降至最低；糖化血红蛋白(hemoglobin A1c, HbA1c)在术后9个月降至最低。术后12、24、36个月FPG和HbA1c均较术前明显降低，差异均有统计学意义(P< 0.05)。术后3年的三酰甘油、高密度脂蛋白及低密度脂蛋白也较术前明显改善，差异均有统计学意义(P< 0.05)。术后出现胃肠吻合口狭窄1例，小肠Y吻合口出血1例。

结论

LGBP对于中国T2DM患者中远期疗效仍是安全、有效的。

关键词: 腹腔镜, 胃旁路术, 2型, 　糖尿病, 减重手术

Objective

To investigate the curative effect of laparoscopic gastric bypass (LGBP) on type 2 diabetes mellitus(T2DM) for 3 years in China.

Methods

Clinical data of 58 patients with T2DM undergoing LGBP from Apr.2012 to Mar. 2014 was studied retrospectively. Weight, blood glucose, blood lipids and surgical complications were observed in 3, 6, 9, 12, 24 and 36 months after operation, and compared by t-test or rank sum test.

Results

Among 58 cases of T2DM patients were successfully completed LGBP without conversion to laparotomy. Weight reached the lowest level at 9 months after LGBP. The average weight were lower respectively at 12, 24 and 36 months postoperatively compared with preoperative (P< 0.05). The complete remission rate of T2DM were 72.5%, 71.4% and 52.9% respectively at 12, 24 and 36 months after operation. Fasting plasma glucose(FPG)decreased to a minimum level at 6 months after operation. Hemoglobin A1c (HbA1c) fell to a minimum level 9 months postoperatively. FPG and HbA1c were lower respectively at 12, 24 and 36 months postoperatively compared with preoperative (P< 0.05). Triglycerides, high density lipoprotein and low density lipoprotein were significantly improved three years after LGBP compared with preoperative (P< 0.05). There were 1 case of gastrointestinal anastomotic stenosis and 1 case of Y anastomotic bleeding in small intestine after LGBP.

Conclusions

LGBP is safe and effective in the mid-term effect of T2DM in China.

Key words: Laparoscopic, Gastric bypass, Type 2, Diabetes mellitus, Bariatric surgery

表1 腹腔镜胃旁路手术前后糖代谢指标的比较

时间	例数	FPG(mmol/L，±s)	HbAlc(%, ±s)	HbA1c≤6.5%[例(%)]
术前	58	7.73±2.63	8.5±1.7	－
术后3个月	48	6.58±1.40^a	6.3±1.0^a	－
术后6个月	45	6.12±1.11^a	6.2±1.0^a	－
术后9个月	41	6.41±1.42^a	6.0±1.5^a	－
术后12个月	40	6.42±2.11^a	6.1±1.1^a	29(72.5)^b
术后24个月	35	6.49±1.49^a	6.3±1.1^a	25(71.4) ^b
术后36个月	34	6.91±1.53^a	6.7±1.2^a	18(52.9)^b

表1 腹腔镜胃旁路手术前后糖代谢指标的比较

时间	例数	FPG(mmol/L，±s)	HbAlc(%, ±s)	HbA1c≤6.5%[例(%)]
术前	58	7.73±2.63	8.5±1.7	－
术后3个月	48	6.58±1.40^a	6.3±1.0^a	－
术后6个月	45	6.12±1.11^a	6.2±1.0^a	－
术后9个月	41	6.41±1.42^a	6.0±1.5^a	－
术后12个月	40	6.42±2.11^a	6.1±1.1^a	29(72.5)^b
术后24个月	35	6.49±1.49^a	6.3±1.1^a	25(71.4) ^b
术后36个月	34	6.91±1.53^a	6.7±1.2^a	18(52.9)^b

表2 腹腔镜胃旁路手术前后降血糖药物使用比较[例(%)]

时间	例数	未使用药物	使用药物			P值
时间	例数	未使用药物	口服降血糖药	胰岛素	口服降血糖药＋胰岛素	P值
术前	58	－	33(56.9)	11(19.0)	14(24.0)	－
术后12个月	56	39(69.6)	5(8.9)	12(21.4)	0(0.0)	< 0.001
术后24个月	52	41(78.8)	5(9.6)	4(7.7)	2(3.8)	< 0.001
术后36个月	40	30(75.0)	5(12.5)	4(10.0)	1(2.5)	< 0.001

表2 腹腔镜胃旁路手术前后降血糖药物使用比较[例(%)]

时间	例数	未使用药物	使用药物			P值
时间	例数	未使用药物	口服降血糖药	胰岛素	口服降血糖药＋胰岛素	P值
术前	58	－	33(56.9)	11(19.0)	14(24.0)	－
术后12个月	56	39(69.6)	5(8.9)	12(21.4)	0(0.0)	< 0.001
术后24个月	52	41(78.8)	5(9.6)	4(7.7)	2(3.8)	< 0.001
术后36个月	40	30(75.0)	5(12.5)	4(10.0)	1(2.5)	< 0.001

表3 腹腔镜胃旁路手术前后血脂的比较(mmol/L，±s)

时间	例数	TG	TCHO	HDL	LDL
术前	58	2.30±2.11	4.79±0.92	1.14±0.23	2.76±0.77
术后3个月	46	1.24±0.68^a	4.38±0.80^a	1.25±0.31^a	2.59±0.62^a
术后6个月	43	1.09±0.61^a	4.15±0.68^a	1.47±0.62^a	2.25±0.57^a
术后9个月	39	1.37±0.82^a	4.35±0.81^a	1.43±0.62^a	2.48±0.69^a
术后12个月	40	1.07±0.54^a	4.25±0.80^a	1.43±0.33^a	2.39±0.65^a
术后24个月	34	1.23±0.90^a	4.47±0.79	1.47±0.32^a	2.60±0.68
术后36个月	28	1.22±0.68^a	4.57±0.91	1.47±0.42^a	2.71±0.88^a

表3 腹腔镜胃旁路手术前后血脂的比较(mmol/L，±s)

时间	例数	TG	TCHO	HDL	LDL
术前	58	2.30±2.11	4.79±0.92	1.14±0.23	2.76±0.77
术后3个月	46	1.24±0.68^a	4.38±0.80^a	1.25±0.31^a	2.59±0.62^a
术后6个月	43	1.09±0.61^a	4.15±0.68^a	1.47±0.62^a	2.25±0.57^a
术后9个月	39	1.37±0.82^a	4.35±0.81^a	1.43±0.62^a	2.48±0.69^a
术后12个月	40	1.07±0.54^a	4.25±0.80^a	1.43±0.33^a	2.39±0.65^a
术后24个月	34	1.23±0.90^a	4.47±0.79	1.47±0.32^a	2.60±0.68
术后36个月	28	1.22±0.68^a	4.57±0.91	1.47±0.42^a	2.71±0.88^a

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Analysis of 3-year effect of gastric bypass on type 2 diabetes mellitus

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Analysis of 3-year effect of gastric bypass on type 2 diabetes mellitus