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中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (03) : 152 -157. doi: 10.3877/cma.j.issn.1674-6899.2023.03.006

论著

胃旁路术对2型糖尿病患者的长期疗效分析
闫文貌1, 李有国1, 许峻1, 钟志强1, 邢颖1, 闫鸣1, 白日星2,†()   
  1. 1. 100070　北京，首都医科大学附属北京天坛医院普外科
    2. 101149　北京，首都医科大学附属北京潞河医院普外科
  • 收稿日期:2023-04-05 出版日期:2023-06-30
  • 通信作者: 白日星
  • 基金资助:
    首都卫生发展科研专项重点项目(2020-1-2021)

Analysis of the long-term efficacy of gastric bypass surgery on patients with type 2 diabetes mellitus

Wenmao Yan1, Youguo Li1, Jun Xu1, Zhiqiang Zhong1, Ying Xing1, Ming Yan1, Rixing Bai2,†()   

  1. 1. Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
    2. Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
  • Received:2023-04-05 Published:2023-06-30
  • Corresponding author: Rixing Bai
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闫文貌, 李有国, 许峻, 钟志强, 邢颖, 闫鸣, 白日星. 胃旁路术对2型糖尿病患者的长期疗效分析[J]. 中华腔镜外科杂志(电子版), 2023, 16(03): 152-157.

Wenmao Yan, Youguo Li, Jun Xu, Zhiqiang Zhong, Ying Xing, Ming Yan, Rixing Bai. Analysis of the long-term efficacy of gastric bypass surgery on patients with type 2 diabetes mellitus[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(03): 152-157.

目的

探讨胃旁路术(Roux-en-Y gastric bypass, RYGB)对2型糖尿病(Type 2 diabetes mellitus, T2DM)患者的长期疗效及安全性。

方法

检索首都医科大学附属北京天坛医院接受RYGB治疗的T2DM患者，选取术后随访满5年、数据完善的病例，分析术前、术后患者的体重、血糖、合并疾病、营养等指标的变化以及手术远期并发症发生情况。

结果

37例行RYGB的T2DM患者入组。平均随访6.2(5.0~9.0)年。术后5年，体重、糖化血红蛋白(HbA1c)均较术前明显减低，差异均有统计学意义(P均<0.05)。术后5年仅有29.7%的患者使用降糖药物，较术前的糖尿病用药情况明显减低，差异有统计学意义(P<0.01)。术后5年T2DM的完全缓解率为29.7%。与术前相比，术后5年甘油三酯(triglyceride，TG)明显减低，高密度脂蛋白(high density lipoprotein，HDL)明显升高，脂代谢异常以及肝功能异常人数明显减少，差异均有统计学意义(P均<0.05)。在营养方面，术后5年铁蛋白水平较术前明显减低，差异有统计学意义(P<0.05)。血红蛋白、白蛋白、叶酸、维生素B12均较术前减低，但差异无统计学意义(P均>0.05)。术后5年1例(3.0%)伴有反复不全肠梗阻症状，2例(6.0%)新发胆囊结石，6例(18.2%)出现缺铁性贫血。

结论

RYGB对于T2DM患者远期仍是安全、有效的。RYGB术后存在体重、血糖反弹、营养障碍等风险。术后应重视患者的随访、饮食及用药指导，RYGB术后患者要预防性补充铁剂、维生素及各种微量元素。

关键词: 腹腔镜, 胃旁路术, 糖尿病，2型, 减重手术, 长期疗效
Objective

To investigate the long-term efficacy and safety of gastric bypass(Roux-en-Y gastric bypass, RYGB)on patients with type 2 diabetes mellitus(T2DM).

Methods

T2DM patients who received RYGB in Beijing Tiantan Hospital Affiliated to Capital Medical University were retrieved from Bariatric and Metabolic Surgery Database. Cases with complete data after 5 years of postoperative follow-up were selected to analyze the preoperative and postoperative weight, blood glucose, and combined changes in indicators such as disease and nutrition, as well as the occurrence of long-term complications of surgery.

Results

Thirty-seven patients with T2DM undergoing RYGB were enrolled. The mean follow-up was 6.2(5.0-9.0)years. Five years after operation, body weight and glycosylated hemoglobin(HbA1c) of all were significantly lower than those before operation, and the differences were statistically significant (all P values were less than 0.05). Only 29.7% of the patients used hypoglycemic drugs 5 years after operation, which was significantly lower than that before operation, and the difference was statistically significant(P<0.01). The complete remission rate of T2DM after 5 years was 29.7%. Compared with before operation, triglyceride(TG)was significantly reduced, high-density lipoprotein(HDL)was significantly increased, and the number of abnormal lipid metabolism and abnormal liver function were significantly reduced at 5 years after operation, and the differences were statistically significant(P value are less than 0.05). In terms of nutrition, the level of ferritin at 5 years after operation was significantly lower than that before operation, and the difference was statistically significant(P<0.05). Hemoglobin, albumin, folic acid, and vitamin B12 were all lower than those before operation, but the differences was not statistically significant(all P values were greater than 0.05). Five years after operation, 1 case(3.0%)was accompanied by symptoms of recurrent incomplete intestinal obstruction, 2 cases(6.0%)developed new gallbladder stones, and 6 cases(18.2%)developed iron deficiency anemia.

Conclusion

In the long run, RYGB is safe and effective for T2DM patients. After RYGB, there are risks such as weight, blood sugar rebound, and nutritional disorders. Postoperative follow-up, diet and medication guidance should be paid attention to. Patients after RYGB should be supplemented with iron, vitamins and various trace elements preventively.

Key words: Laparoscopy, Gastric bypass, Type 2, diabetes mellitus, Bariatric surgery, Long-term outcomes
表1 腹腔镜胃旁路术手术前后各项计量指标变化(±s)(非参数检验)
项目 术前(例) 术后5年(例) P值
体重(kg) 84.6±17.3(37) 67.1±12.2(37)a 0.001
BMI(kg/m2) 30.9±5.0(37) 24.6±3.9(37)a 0.001
FPG(mmol/L) 7.4±3.4(37) 6.5±1.3(37) 0.619
HbA1c (%) 8.2±1.7(36) 6.5±0.9(36)a 0.001
TG(mmol/L) 2.1±1.9(36) 1.2±0.7(36)a 0.037
CHO(mmol/L) 4.5±0.9(36) 4.3±0.7(36) 0.504
HDL(mmol/L) 1.1±0.3(35) 1.4±0.3(36)a 0.001
LDL(mmol/L) 2.8±0.6(36) 2.6±0.6(36) 0.336
ALT(U/L) 33.5±18.7(36) 20.7±6.8(36)a 0.004
AST(U/L) 21.6±9.0(36) 22.1±7.2(35) 0.694
CREA(μmol/L) 54.3±16.2(36) 58.4±15.8(35) 0.601
UA(μmol/L) 320.1±115.0(36) 313.4±95.0(36) 0.336
HGB(g/L) 133.9±14.3(37) 126.3±19.2(33) 0.366
ALB(g/L) 44.9±2.8(37) 44.5±2.7(34) 0.665
SF(ng/mL) 137.6±138.5(33) 32.1±29.4(32)a 0.001
FA(ng/mL) 18.1±6.7(32) 17.1±8.6(28) 0.308
VB12(pg/mL) 563.3±496.4(33) 420.7±304.6(27) 0.196
表2 腹腔镜胃旁路术手术前后各项计数资料比较(卡方检验，Fisher精确检验)[n(%)]
项目(例) 术前 术后5年 P值
正常 异常 正常 异常
降糖药物 0(0) 37(100) 26(70.3) 11(29.7) 0.001a
降压药物 30(81.1) 7(18.9) 35(94.6) 2(5.4) 0.075
血脂异常 18(50.0) 18(50.0) 27(75.0) 9(2.05) 0.028a
转氨酶 27(75.0) 9(25.0) 36(100) 0(0) 0.002a
CREA 35(97.2) 1(2.8) 34(97.1) 1(2.9) 0.984
UA 34(94.4) 2(5.6) 31(86.1) 5(13.9) 0.429
HGB 36(97.3) 1(2.7) 27(81.8) 6(18.2) 0.038a
ALB 36(97.3) 1(2.7) 33(97.1) 1(2.9) 1.000
SF 32(97.0) 1(3.0) 24(75.0) 8(25.0) 0.013a
FA 33(100) 0(0) 28(100) 0(0) －
VB12 32(97.0) 1(3.0) 24(88.9) 3(11.1) 0.318
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