腹腔镜胃旁路术治疗低体质量指数2型糖尿病的临床疗效

Clinical effect of laparoscopic gastric bypass for the treatment of type 2 diabetes mellitus patients with low body mass index

    摘要
  • 摘要: 目的:探讨腹腔镜胃旁路术(LRYGB)治疗低BMI 2型糖尿病患者的临床疗效。
    方法:回顾性分析2010年4月至2015年2月第三军医大学大坪医院收治的70例行LRYGB的2型糖尿病患者的临床资料。30例患者BMI>30 kg/m2，设为高BMI组；40例患者BMI<30 kg/m2，设为低BMI组。参照《中国肥胖和2型糖尿病外科治疗指南(2014)》疗效评价标准评价患者术后糖尿病转归情况。采用住院、门诊和电话方式进行随访，随访时间截至2015年2月。术后1、3、6、12、24个月定期随访，检测BMI、腹围、空腹血糖、糖化血红蛋白、血压、TC、TG、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇。正态分布的计量资料以 ±s表示，采用独立样本t检验；重复测量数据采用重复测量的方差分析。率的比较采用χ2检验。
    结果:70例患者均顺利完成LRYGB，围术期无死亡、出血、肠梗阻等发生。70例患者均获得术后随访，中位随访时间为6个月(1～24个月)。5例术后发生并发症，其中吻合口漏1例，胃空肠吻合口狭窄1例，吻合口溃疡2例，贫血1例，均经对症治疗后缓解。高BMI组和低BMI组患者手术前后，BMI、腹围、糖化血红蛋白、血压、TC、TG、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇分别为(35.4 ±4.5)kg/m2～(24.9±1.5)kg/m2和(26.8±2.3)kg/m2～(21.9±2.0)kg/m2，(110±15)cm～(81±8)cm和(92±8)cm～(79±8)cm，6.4%± 1.4%～6.0%±0.5%和6.3%±2.1%～6.2%±0.8%，(133±15)mmHg～(132±10)mmHg/(75±9)mmHg～(73±4)mmHg和(133±11)mmHg～(132±14)mmHg/(74±8)mmHg～(72±7)mmHg(1 mmHg= 0.133 kPa)，(6.0±2.3)mmol/L～(5.0±1.8)mmol/L和(4.9±1.2)mmol/L～(4.0±0.5)mmol/L，(3.2±1.7)mmol/L～(1.0±0.2)mmol/L和(3.6±2.6)mmol/L～(1.0±0.4)mmol/L，(1.0±0.2)mmol/L～ (1.6±0.3)mmol/L和(1.2±0.8)mmol/L～(1.3±0.2)mmol/L，(3.0±0.7)mmol/L～(2.9±1.2)mmol/L和(2.5±0.7)mmol/L～(2.5±0.9)mmol/L，其变化趋势比较，差异均无统计学意义(F=1.65，1.72，0.75，1.04，0.98，1.53，1.70，1.05，0.84，P>0.05)；空腹血糖分别为(8.6±3.5)mmol/L～(5.6±0.9)mmol/L和(8.6±3.3)mmol/L～(6.5±1.7)mmol/L，其变化趋势比较，差异有统计学意义(F=2.21，P<0.05)。高BMI组患者术后3、6、12、24个月空腹血糖低于低BMI组患者，两组比较，差异均有统计学意义(t=2.87， 3.88，3.10，2.80，P<0.05)。高BMI组30例患者中完全缓解26例，部分缓解4例；低BMI组40例患者中完全缓解28例，部分缓解8例，明显改善3例，无效1例，两组比较，差异有统计学意义(χ2=4.69， P<0.05)。
    结论:LRYGB治疗2型糖尿病安全、可行，尽管BMI<30 kg/m2的2型糖尿病患者完全缓解率低于BMI> 30 kg/m2的患者，但其综合疗效仍然是值得肯定的。

     

    Abstract: Objective:To evaluate the clinical effect of laparoscopic RouxenY gastric bypass (LRYGB) for the treatment of type 2 diabetes mellitus patients with low body mass indexes (BMI).
    Methods:The clinical data of 70 patients with type 2 diabetes mellitus who underwent LRYGB at Daping Hospital of Third Military Medical University from April 2010 to February 2015 were retrospectively analyzed. Thirty patients with BMI>30 kg/m2 were allocated to the high BMI group, and 40 patients with BMI<30 kg/m2 were allocated to the low BMI group.The postoperative prognosis of diabetes mellitus in patients was evaluated according to “Guidelines for surgical treatment of obesity and type 2 diabetes mellitus in China (2014)”. The patients were followed up by inpatient, outpatient examination and telephone interview till February 2015. Body weight, abdominal perimeter, fasting blood glucose, glycosylated hemoglobin (HbAlc), blood pressure, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDLC) and low density lipoprotein cholesterol (LDLC) were regularly detected at postoperative month 1, 3, 6, 12, 24. Measurement data with normal distribution were presented as ±s and were analyzed by the t test. Repeated measures data were analyzed by the repeated measures ANOVA. The comparison of rate was analyzed using the chisquare test.
    Results:All the 70 patients underwent successfully LRYGB without death, hemorrhage or intestinal obstruction in the perioperative period and received followup with a median time of 6 months (range, 1-24 months). Five patients had postoperative complications, including 1 case of stomal leakage, 1 of gastricjejunal stoma stenosis, 2 of stomal ulcer and 1 of anemia, and had remission of symptoms after symptomatic treatment. The BMI, abdominal perimeter, HbAlc, blood pressure, TC, TG, HDLC, LDLC before and after operation between the high BMI and low BMI group were (35.4±4.5)kg/m2-(24.9±1.5)kg/m2 and (26.8±2.3)kg/m2-(21.9±2.0)kg/m2, (110±15)cm-(81±8)cm and (92± 8)cm-(79±8)cm, 6.4%±1.4%-6.0%±0.5% and 6.3%±2.1%-6.2%±0.8%, (133±15)mmHg-(132±10)mmHg/(75±9)mmHg-(73±4)mmHg (1 mmHg=0.133 kPa) and (133±11)mmHg-(132±14)mmHg/(74±8)mmHg-(72±7)mmHg, (6.0±2.3)mmol/L-(5.0±1.8)mmol/L and (4.9±1.2)mmol/L-(4.0± 0.5)mmol/L, (3.2±1.7)mmol/L-(1.0±0.2)mmol/L and (3.6±2.6)mmol/L-(1.0±0.4)mmol/L, (1.0±0.2)mmol/L-(1.6±0.3)mmol/L and (1.2±0.8)mmol/L-(1.3±0.2)mmol/L, (3.0±0.7)mmol/L- (2.9±1.2)mmol/L and (2.5±0.7)mmol/L-(2.5±0.9)mmol/L, respectively, with no significant differences in the changing trends (F=1.65, 1.72, 0.75, 1.04, 0.98, 1.53, 1.70, 1.05, 0.84, P>0.05). The fasting blood glucose before and after operation in the high BMI group and low BMI group were (8.6±3.5)mmol/L- (5.6±0.9)mmol/L and (8.6±3.3)mmol/L-(6.5±1.7)mmol/L, respectively, with a significant difference in the changing trends (F=2.21, P<0.05). The fasting blood glucose in the high BMI group at postoperative 3, 6, 12, 24 month were lower than those in the low BMI group (t=2.87, 3.88, 3.10, 2.80, P<0.05). Twentysix patients had complete remission and 4 patients had partial remission in the high BMI group, among 40 patients in the low BMI group, 28 patients had complete remission, 8 patients had partial remission, 3 patients had significant improvement and 1 patient had nonremission, with a significant difference (χ2=4.69, P<0.05).
    Conclusion LRYGB is safe and feasible for the treatment of type 2 diabetes mellitus with a good comprehensive therapeutic effect, although complete remission rate of patients with BMI<30 kg/m2 is lower than patients with BMI>30 kg/m2.

     

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