Abstract: Objective:To investigate the efficacies of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery in the treatment of patients with different body mass indexes (BMI) and type 2 diabetes mellitus.
Methods:The clinical data of 40 patients with type 2 diabetes mellitus who underwent LRYGB surgery at the Shengjing Hospital of China Medical University from January 2013 to December 2013 were retrospectively analyzed. According to different BMI, 8 patients with BMI<27.5 kg/m2 were allocated into group 1, 14 patients with BMI≥27.5 kg/m2 and <32.5 kg/m2 in group 2 and 18 patients with BMI≥32.5 kg/m2 in group 3. Forty patients were followed up via telephone interview and food habits questionnaire by weight loss file managers of Shengjing Hospital and the fourth Affiliated Hospital of China Medical University. All the patients received the reexamination of blood test and data collection at postoperative year 1. The preoperative and postoperative 1year fasting plasma glucose, glycosylated hemoglobin (HbA1c), BMI and Cpeptide were collected and detected. The fasting plasma glucose<7.00 mmol/L and HbA1c<7.00% were used as a standard of complete remission. Count data and comparison of rates were analyzed using the chisquare test. Measurement data with normal distribution were presented as ±s and analyzed by the t test. Skew distribution data were described as M(range) and analyzed by the Wilcoxon rank sum test. Repeated measurement data were analyzed by the repeated measures ANOVA.
Results:Forty patients received successful LRYGB surgery without perioperative complications, and were followed up for 1 year at the Shengjing Hospital (23 patients), the fourth Affiliated Hospital (8 patients) and other hospitals (9 patients). Of the 40 patients, 85.0%(34/40) of patients had no postoperative longterm obvious malnutrition, anastomotic stenosis，ion disorders and digestive tract dynamic obstacles, 15.0%(6/40) of patients were not adapted to the change of life habits such as frequent nausea and vomiting. Five patients with different degrees of frequent vomiting, abdominal pain and night heartburn within postoperative 1 month had the remission of symptoms after symptomatic treatment. One patient in group 2 had a symptom of hypertonic coma due to intake of oral highsugar drinks at postoperative 1 week and then was cured by hospitalization. The fasting plasma glucose, HbA1c and BMI in group 1 from preoperation to postoperation were decreased from 11.07 mmol/L (range, 6.00-17.00 mmol/L) to 7.18 mmol/L (range, 6.00-15.00 mmol/L), from 8.85% (range, 6.00%-11.00%) to 6.35% (range, 6.00%-9.00%) and from 26.0 kg/m2 (range, 22.0-27.0 kg/m2) to 22.2 kg/m2 (range, 20.0-25.0 kg/m2) , with significant differences (F=2.413, 3.256, 6.750, P<0.05). Cpeptide from preoperation to postoperation was decreased from 1.20 nmol/L (range, 1.00-3.00 nmol/L) to 1.07 nmol/L (range, 1.00-2.00 nmol/L)，with no significant difference (F=1.678, P>0.05). The remission rate of diabetes in group 1 was 3/8. The fasting plasma glucose and HbA1c in group 2 from preoperation to postoperation were decreased respectively from 10.73 mmol/L (range, 7.00-19.00 mmol/L) to 5.89 mmol/L (range, 5.00-9.00 mmol/L) and from 8.00% (range, 6.00%-15.00%) to 5.85% (range, 5.00%-8.00%). The BMI from preoperation to postoperation was decreased from 31.0 kg/m2 (range, 29.0-32.0 kg/m2) to 25.5 kg/m2 (range, 21.0-29.0 kg/m2), with significant differences in the above 3 indexes (F=5.449,4.008,-3.296, P<0.05). Cpeptide from preoperation to postoperation was decreased from 1.53 nmol/L (range, 1.00-5.00 nmol/L) to 1.52 nmol/L (range, 1.00- 6.00 nmol/L), with no significant difference (F=-0.251, P>0.05). The remission rate of diabetes in group 2 was 10/14. The fasting plasma glucose, HbA1c and BMI in group 3 from preoperation to postoperation were decreased from 9.44 mmol/L (range, 5.00-16.00 mmol/L) to 6.65 mmol/L (range, 4.00-15.00 mmol/L), from 7.90% (range, 6.00%-11.00%) to 6.45% (range, 5.00%-9.00%) and from 36.9 kg/m2 (range, 33.0-47.0 kg/m2) to 27.7 kg/m2 (range, 23.0-34.0 kg/m2), with significant differences (F=-3.027, -3.410,-3.724, P<0.05). Cpeptide from preoperation to postoperation was decreased from 2.91 nmol/L (range, 0.00-9.00 nmol/L) to 2.13 nmol/L (range, 0.00-6.00 nmol/L)，with no significant difference (F= -3.724, P>0.05). The remission rate of diabetes in group 3 was 14/18. There was no significant difference in the remission rate of diabetes of 3 groups (χ²=4.460, P>0.05). There were significant differences in the changing trends of fasting plasma glucose and BMI among the 3 groups (F=3.200, 22.500, P<0.05). There were no significant differences in the changing trends of HbA1c and Cpeptide among the 3 groups (F=0.720,1.640, P>0.05).
Conclusion:LRYGB surgery is feasible for the treatment of type 2 diabetes mellitus with effectively decreasing fasting glucose, and should be performed on patients with BMI≥ 27.5 kg/m2 instead of patients with BMI<27.5 kg/m2 according to a correlation of blood glucose control and preoperative BMI.